Breath-Holding Test After Deep Inhalation as a Risk Predictor of Adverse Events After Elective Abdominal Surgery in Children: Prospective Cohort Study

Background. Early postoperative adverse events in children remain a significant clinical problem, their prognosis via multifactorial scales has several limitations (complexity, subjective assessment, insufficient accuracy). Thus, the search for accurate and non-invasive methods for assessing risk of postoperative events remains relevant.

Objective. The aim of the study is to examine the prognostic value of breath-holding test (BHT) duration after deep inhalation in assessing the risk of adverse events after elective abdominal surgery in children.

Methods. The single-center prospective cohort study included children aged 5–10 years with ASA I–II physical status and planned abdominal surgery. All participants were measured BHT duration (in seconds) three times after deep inhalation with calculating the mean value (at the preoperative stage — the day before anesthesia). Any adverse postoperative events were recorded during the first 6 hours after surgery: pain, postoperative nausea and vomiting, shivering, and agitation. The predictive BHT efficacy was analyzed via multivariate logistic regression and k-fold cross-validation.

Results. The study included 160 children. Adverse postoperative events were reported in 36 (22.5%) cases. BHT duration after deep inhalation was the only statistically significant predictor of adverse events in the multivariate logistic regression model: AUC — 0.833 (95% confidence interval (CI) 0.781–0.894), odds ratio — 0.82 (95% CI 0.77–0.88). BHT duration did not change significantly during cross-validation of predictive performance metrics. The optimal value for the development of adverse postoperative events prognosis was BHT duration  28 seconds. The frequency of adverse postoperative events in children with high postoperative risk (BHT  28 seconds) was more than twice as much as in children with BHT > 28 seconds (16.3 and 6.2%, respectively; p < 0.001).

Conclusion. BHT test after deep inhalation is a simple and non-invasive method to stratify risk while planning abdominal surgery in children. The BHT duration  28 seconds is the independent predictor of adverse events after such surgeries.

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