Impact of oculorespiratory reflex on postoperative recovery following pediatric strabismus surgery: a retrospective cohort study

The Oculorespiratory Reflex (ORR) is a common intraoperative reflex observed in pediatric patients undergoing strabismus surgery. Despite its prevalence, the potential association between ORR and postoperative complications has not been thoroughly investigated. This retrospective cohort study included pediatric patients who underwent strabismus surgery at Tianjin Eye Hospital between October 2024 and April 2025. ORR was defined as a > 20% reduction from baseline in tidal volume, minute ventilation, or respiratory rate, or the occurrence of apnea during surgery. Postoperative recovery was assessed based on two primary outcomes: postoperative nausea and vomiting (PONV) and postoperative agitation (PA). Propensity score matching (PSM) was applied to balance potential confounding variables between patients with and without ORR. A total of 250 pediatric patients were analyzed, of whom 119 (47.6%) developed ORR. After PSM, 119 ORR patients and 119 matched controls were included in the analysis. Among them, 32 patients experienced PONV, and 23 experienced PA. Multivariate logistic regression revealed that ORR was not significantly associated with PONV (OR = 0.168, 95% CI: 0.022–1.002; P = 0.065), but it was identified as a significant risk factor for PA (OR = 8.301, 95% CI: 1.295–61.377; P = 0.029). Intraoperative occurrence of ORR may serve as an indicator for predicting PA in pediatric patients undergoing strabismus surgery. These findings highlight the importance of monitoring ORR to better anticipate and manage postoperative agitation, thereby improving postoperative outcomes. Not applicable.