ANESTHESIOLOGICAL DETERMINANTS OF PERIOPERATIVE OUTCOMES IN CHILDREN WITH INTESTINAL OBSTRUCTION

Abstract

Intestinal obstruction in infants and young children is associated with high perioperative morbidity and mortality. Besides surgical factors, anesthesiological management and perioperative intensive care may significantly influence outcomes. Objective.This study aimed to identify perioperative predictors of adverse outcomes in children with intestinal obstruction and to evaluate anesthesiological management strategies. Methods. A retrospective observational study was conducted at the Andijan Regional Multidisciplinary Medical Center. Medical records of 99 children aged 0-3 years who underwent emergency surgery for intestinal obstruction were analyzed. Demographic, clinical, anesthetic, and perioperative variables were evaluated. Binary logistic regression and receiver operating characteristic (ROC) analysis were applied to identify independent predictors of adverse outcomes. Results. Adverse outcomes (severe complications and/or death) occurred in 34.3% of patients. Operation duration was identified as an independent predictor of adverse outcome (OR 1.064 per minute; 95% CI 1.023-1.107; p=0.002). Delayed hospital admission (>24 h) showed a borderline association with adverse outcome (p=0.057). The regression model demonstrated acceptable discrimination (AUC=0.722). Late hospital admission (>24 hours) was marginally associated with adverse outcomes (p=0.057). The regression model had satisfactory discriminant ability, with an area under the ROC curve (AUC) of 0.722. According to the results of the analysis, the duration of surgery was identified as an independent and reliable predictor of adverse clinical outcomes (OR=1.078; 95% CI: 1.028-1.131; p=0.002). This indicates that each additional minute of surgery increases the probability of developing an adverse clinical outcome by an average of 7-8%. This suggests that metabolic disorders associated with prolonged surgical time and increased surgical stress negatively affect clinical outcomes. Also, late hospital presentation (>24 hours) was noted as a significant factor significantly increasing the risk of adverse clinical outcomes (OR=9.20; 95% CI: 1.62-52.38; p=0.012). This result can be explained by the late diagnosis of the disease, increased risk of intestinal ischemia and infectious-septic complications. The type of anesthesia, in particular multimodal anesthesia, did not reach independent statistical significance within the multivariate model (p=0.301). Conclusion. Perioperative factors, particularly operation duration, play a critical role in determining outcomes in pediatric intestinal obstruction. Early hospital admission and optimization of anesthesiological management may contribute to improved clinical results.