Pediatric Retropharyngeal Abscess: Factors Predictive of Increased Length of Stay

Introduction: Retropharyngeal abscess (RPA) is a rare but potentially life-threatening condition with a relatively higher prevalence among children. This multicenter database study aims to identify factors associated with prolonged length of stay (LOS) following surgical drainage of RPA using the American College of Surgeons’ National Surgical Quality Improvement Program-Pediatric (ACS NSQIP-P).

Methods: The ACS NSQIP-P database was queried for patients with a postoperative diagnosis of retropharyngeal and parapharyngeal abscess (J39.0) following incision and drainage between 2015 and 2023. Demographic and treatment-related characteristics were analyzed using SPSS. A linear regression model was used to evaluate predictors of LOS, defined as days from operation to discharge.

Results: A total of 709 cases met the study’s inclusion criteria. Key demographic data are shown in Table 1. The linear regression model was statistically significant (R² = 0.405, adjusted R² = 0.164, F-statistic = 10.806, P <.001). Non-White race, oxygen support, neuromuscular disorder, and total operation time were significant predictors of increased postoperative LOS. Non-White race increased LOS by 5.1 hours (P =.024). Oxygen support increased LOS by 9.7 days (P <.001). Presence of neuromuscular disorder increased LOS by 9.1 days (P =.037). Each additional minute of operation time increased LOS by 30.2 minutes (P =.010).

Conclusions: Non-White race, oxygen support, neuromuscular disorders, and length of operation time were the strongest predictors of prolonged LOS following RPA drainage in pediatric patients. This study provides clinicians with valuable insights to guide discharge planning and optimize care for patients with complex needs. Special attention should be given to patients requiring oxygen support or with pre-existing neuromuscular conditions, as they may benefit from enhanced discharge coordination.