Patient and operative factors associated with unanticipated intensive care admission and outcomes following posterior fossa decompressions in children: A retrospective study.


  • This retrospective chart review examined the medical records of all patients under 18 years who underwent surgery for Chiari I malformation between 2009 and 2021 at a single specialist centre in Chicago.
  • The primary outcome was the incidence of unanticipated admission to ICU with the primary variable of interest being anaesthesia-related complications.
  • 296 patients were identified. 25 patients (8.4%) had 29 anaesthesia-related intraoperative complications.
  • 5 patients (0.7%) had unanticipated ICU admission
  • Only 2 of these had intraoperative anaesthesia-related complications
  • The other 3 did not have any intraoperative anaesthesia-related complications but had significant pre-existing medical conditions deserving of elective post-operative ICU admission but was not arranged prior to the day of surgery.
  • The authors stated that clinical characteristics contributing to an unanticipated admission to ICU were younger age, ASA >2 and anaesthesia-related complications.

Comments/Take Home message

  • The low unanticipated ICU admission rate is reassuring, but the numbers are too small to draw any conclusions about the contribution of anaesthesia to clinical outcomes.
  • The definition of anaesthesia-related complications is also debatable. Perhaps the term “anaesthesia-managed complications” is more appropriate. For example, bradycardia could be related to anaesthesia medications or surgical stimulation of the brain stem.
  • Future studies would require prospective observation and tighter definition of anaesthesia-related complications.

Reviewed by Dr Michael Tan