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Background <p>Postoperative hypoxemia is a critical complication in pediatric (≤ 18&#xa0;years) patients undergoing non-cardiac surgeries with endotracheal intubation, which will potentially lead to poorer outcomes. Despite its clinical significance, systematic approaches to ascertain prevalence and risk factors are lacking. Thus, our study aims to conduct a systematic review and meta-analysis to assess the prevalence of postoperative hypoxemia in pediatric patients following endotracheal intubation for non-cardiac procedures and to identify associated risk factors.</p> Methods <p>A comprehensive search of PubMed, Ovid, Embase, Web of Science, and Cochrane Library was conducted from inception to November 30, 2024, using terms related to children, postoperative, and hypoxemia. Observational and interventional studies reporting postoperative hypoxemia in pediatric patients undergoing non-cardiac surgeries with endotracheal intubation were included. Two reviewers independently extracted data. Random-effects meta-analysis estimated pooled prevalence. Subgroup analyses examined age, publication year, and geographic region. Meta-regression examined surgical types. The primary outcome was the overall incidence of postoperative hypoxemia. The secondary outcomes were the risk factors related to postoperative hypoxemia.</p> Results <p>A total of 37 studies involving 14,597 patients were identified. The pooled prevalence of postoperative hypoxemia was 10.1% (95% CI: 0.066–0.142). Infants (&lt; 1&#xa0;year) had a higher prevalence than older children (17.5% vs. 7.4%; <i>p</i> = 0.025). Studies published before 2010 reported higher rates (15.4–20.6%) than post-2010 studies (5.5–6.7%). No significant variations were observed across World Health Organization regions, World Bank income classifications or surgical types.</p> Conclusions <p>This study provides a global estimation of postoperative hypoxemia prevalence in pediatric patients undergoing non-cardiac surgeries with endotracheal intubation. Standardizing the definition of hypoxemia in future research is crucial to enhance comparability and clinical relevance.</p> Trial registration <p>The review protocol was registered in advance with PROSPERO (ID CRD42025631572), date of registration: Dec 26 2024.</p>

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Incidence and risk factors of hypoxemia after general anesthesia in children undergoing non-cardiac surgery: a systematic review and meta-analysis

  • 期刊论文

  • 发表日期：

    2026年2月21日

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  • Diwei Zhang,
  • Xia Yu,
  • Yu Cui

摘要

Background

Postoperative hypoxemia is a critical complication in pediatric (≤ 18 years) patients undergoing non-cardiac surgeries with endotracheal intubation, which will potentially lead to poorer outcomes. Despite its clinical significance, systematic approaches to ascertain prevalence and risk factors are lacking. Thus, our study aims to conduct a systematic review and meta-analysis to assess the prevalence of postoperative hypoxemia in pediatric patients following endotracheal intubation for non-cardiac procedures and to identify associated risk factors.

Methods

A comprehensive search of PubMed, Ovid, Embase, Web of Science, and Cochrane Library was conducted from inception to November 30, 2024, using terms related to children, postoperative, and hypoxemia. Observational and interventional studies reporting postoperative hypoxemia in pediatric patients undergoing non-cardiac surgeries with endotracheal intubation were included. Two reviewers independently extracted data. Random-effects meta-analysis estimated pooled prevalence. Subgroup analyses examined age, publication year, and geographic region. Meta-regression examined surgical types. The primary outcome was the overall incidence of postoperative hypoxemia. The secondary outcomes were the risk factors related to postoperative hypoxemia.

Results

A total of 37 studies involving 14,597 patients were identified. The pooled prevalence of postoperative hypoxemia was 10.1% (95% CI: 0.066–0.142). Infants (< 1 year) had a higher prevalence than older children (17.5% vs. 7.4%; p = 0.025). Studies published before 2010 reported higher rates (15.4–20.6%) than post-2010 studies (5.5–6.7%). No significant variations were observed across World Health Organization regions, World Bank income classifications or surgical types.

Conclusions

This study provides a global estimation of postoperative hypoxemia prevalence in pediatric patients undergoing non-cardiac surgeries with endotracheal intubation. Standardizing the definition of hypoxemia in future research is crucial to enhance comparability and clinical relevance.

Trial registration

The review protocol was registered in advance with PROSPERO (ID CRD42025631572), date of registration: Dec 26 2024.