Postoperative pulmonary complications and associated risk factors in children with asthma undergoing surgery

Evidence regarding postoperative pulmonary complications (PPCs) in children with asthma is limited compared with adults. This study aimed to determine the frequency of PPCs and to identify preoperative risk factors in children with asthma undergoing surgery. This retrospective, cross-sectional observational study included children aged 5–18 years with asthma who underwent surgical procedures between January 2022 and January 2025 and were evaluated preoperatively at a tertiary pediatric allergy clinic. Demographic characteristics, clinical and laboratory findings, surgical and anesthetic features, and postoperative follow-up data were collected. Risk factors for PPCs were identified using univariable and multivariable logistic regression analyses. A total of 84 children with asthma were included (male: 82.1%; median age: 8.5 [range: 5–17] years). PPCs occurred in 15 patients (17.9%). PPCs were more common in children undergoing open surgery and in those with uncontrolled asthma, who also had longer post-anesthesia care unit stays. A history of atopic dermatitis and a higher annual number of asthma exacerbations were also associated with PPC development. Multivariable analysis identified uncontrolled asthma, atopic dermatitis, frequent exacerbations, and open surgery as independent risk factors for PPCs (all p < 0.05). PPCs occur at a considerable frequency in children with asthma undergoing surgery. Preoperative asthma control, long-term disease activity, atopic background, and surgical approach appear to play a key role in postoperative respiratory risk. Careful preoperative assessment incorporating these factors may help reduce postoperative morbidity in pediatric patients with asthma.