Peri-anesthesia morbidity among pediatric patients in a national referral mother and child hospital in Indonesia: a prospective observational cohort study
Abstract
Background: Pediatric patients are more susceptible to peri-anesthesia complications due to unique physiological characteristics. The present study assessed peri-anesthesia morbidity and its predictors at a national referral mother-and-child hospital in Indonesia.
Methodology: A prospective observational cohort study (January to June 2024), enrolling children aged 0–15 years undergoing diagnostic or surgical procedures under general anesthesia. Standardized data on patient characteristics, anesthetic practices, critical events, and postoperative disposition were analyzed using descriptive and multivariate analysis.
Results: Among the 825 patients, most were classified as low risk (ASA II, 79.2%) and underwent elective procedures (97.9%). Critical events were rare, including bronchospasm (0.1%), laryngospasm (0.4%), and cardiovascular instability (0.6%), with no reported cases of aspiration, anaphylaxis, medication errors, or cardiac arrest. The majority of patients (92%) were transferred to the ward, while 4.1% required admission to the pediatric intensive care unit (PICU). Emergency procedures and after-hours anesthesia were strongly associated with increased rates of post-anesthesia care unit (PACU) or PICU admissions, with odds ratios of 14.82 and 14.89, respectively. Independent predictors of morbidity included younger age, ASA III–IV status, chronic medication use, disability, emergency procedures, and after-hours anesthesia.
Conclusion: Overall peri-anesthesia morbidity was low; however, vulnerable patient and off-hours or emergencies procedures carried significantly higher risk. Enhancing system preparedness and monitoring during high-risk conditions is essential to improve pediatric anesthesia safety.
Keywords: Critical events; Emergency surgery;, Morbidity; PACU/PICU admission; Pediatric anesthesia.
Citation: Pratiwi A, Ramlan AAW. Peri-anesthesia morbidity among pediatric patients in a national referral mother and child hospital in Indonesia: a prospective observational cohort study. Anaesth. pain intensive care 2026;30(4):471-479. DOI: 10.35975/apic.v30i4.3211
Received: December 09, 2025; Revised: March 17, 2026; Accepted: April 01, 2026
