Open Access Highly Accessed Research article

Impact of perioperative RSV or influenza infection on length of stay and risk of unplanned ICU admission in children: a case-control study

Michael C Spaeder1*, Justin L Lockman2, Robert S Greenberg2, James C Fackler2 and Joanne Shay2

Author Affiliations

1 Department of Pediatrics, The George Washington University School of Medicine and Health Sciences and the Division of Critical Care Medicine, Children's National Medical Center, Washington, DC. USA

2 Division of Pediatric Anesthesia and Critical Care Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD. USA

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BMC Anesthesiology 2011, 11:16  doi:10.1186/1471-2253-11-16

Published: 5 September 2011



Children with viral respiratory infections who undergo general anesthesia are at increased risk of respiratory complications. We investigated the impact of RSV and influenza infection on perioperative outcomes in children undergoing general anesthesia.


We performed a retrospective case-control study. All patients under the age of 18 years who underwent general anesthesia at our institution with confirmed RSV or influenza infection diagnosed within 24 hours following induction between October 2002 and September 2008 were identified. Controls were randomly selected and were matched by surgical procedure, age, and time of year in a ratio of three controls per case. The primary outcome was postoperative length of stay (LOS).


Twenty-four patients with laboratory-confirmed RSV or influenza who underwent general anesthesia prior to diagnosis of viral infection were identified and matched to 72 controls. Thirteen cases had RSV and 11 had influenza. The median postoperative LOS was three days (intra-quartile range 1 to 8 days) for cases and two days (intra-quartile range 1 to 5 days) for controls. Patients with influenza had a longer postoperative LOS (p < 0.001) and patients with RSV or influenza were at increased risk of unplanned admission to the PICU (p = 0.04) than matched controls.


Our results suggest that children with evidence of influenza infection undergoing general anesthesia, even in the absence of symptoms previously thought to be associated with a high risk of complications, may have a longer postoperative hospital LOS when compared to matched controls. RSV and influenza infection was associated with an increased risk of unplanned PICU admission.