Risk Factors for Atelectasis Following Right Subaxillary Small‐Incision Congenital Heart Surgery in Children: A Retrospective Cross‐Sectional Study

ABSTRACT Background Pulmonary complications occur at a notably high frequency following pediatric cardiac surgery, among which atelectasis is highly prevalent. Current research is inadequate regarding the development and risk factors for atelectasis in children. Aims To investigate the incidence of atelectasis on the first day after right subaxillary small‐incision congenital heart disease surgery and to identify risk factors for atelectasis. Methods This study retrospectively collected data on children who underwent elective surgery (procedures: atrial septal defect repair, ventricular septal defect repair, or combined procedures in the left lateral decubitus position) at our hospital. Lung ultrasound findings on postoperative day one were collected to evaluate the incidence of atelectasis. Univariate screening followed by multivariable linear regression modeling was performed to identify risk factors for atelectasis. Results A total of 254 children were included in the data collection, with a median [IQR] age of 37.0 [23.0–58.0] months. The optimal model identified the following independent risk factors for atelectasis: younger age (β = −0.03, 95% CI: −0.04 to −0.02, p < 0.001), higher BMI (β = 0.55, 95% CI: 0.41–0.69, p < 0.001), prolonged anesthesia duration (β = 0.01, 95% CI: 0.004–0.02, p = 0.001), sufentanil dose > 2.0 μg·kg −1 ·h −1 (β = 1.45, 95% CI: 1.01–1.89, p < 0.001), and higher doses of cisatracurium (β = 1.17, 95% CI: 0.65–1.69, p < 0.001), and atelectasis showed an aggravating trend (β = 0.16, 95% CI: 0.09–0.23, p < 0.001). The model demonstrated satisfactory goodness‐of‐fit ( R 2 = 0.699, adjusted R 2 = 0.691, F ‐statistic = 89.068). Conclusion The identified independent risk factors for atelectasis include younger age, higher BMI, prolonged anesthesia duration, sufentanil dose exceeding 2.0 μg·kg −1 ·h −1 and higher doses of cisatracurium, with the severity of atelectasis progressively worsening over time.