Prevalence of Difficult Airway Predictors Among Surgical Patients Undergoing General Anesthesia: A Cross-Sectional Study

Abstract

Background: Difficult airway predictors remain a critical focus in perioperative safety, as failure to identify high-risk patients increases the likelihood of hypoxic injury and adverse anaesthesia-related events. Understanding the prevalence and distribution of these predictors within specific surgical populations is essential for improving airway preparedness and clinical decision-making. Objective: To determine the prevalence of difficult airway predictors among adult surgical patients undergoing general anaesthesia and identify demographic and clinical factors associated with increased risk. Methods: A cross-sectional observational study was conducted among 420 adults scheduled for surgery under general anaesthesia. Standardized preoperative assessments measured Mallampati classification, inter-incisor distance, thyromental distance, neck mobility, neck circumference, and craniofacial characteristics. Logistic regression was used to evaluate associations between patient factors and the presence of ≥1 difficult airway predictor. Results: At least one predictor was present in 34.0% of patients, with Mallampati III–IV (18.6%), short thyromental distance (14.3%), and limited mouth opening (12.1%) being most common. Older age, obesity, and suspected obstructive sleep apnea significantly increased the odds of difficult airway predictors, with adjusted ORs of 1.49, 1.94, and 2.28, respectively. Prevalence was highest in ENT/head-neck (50.0%) and neurosurgical (46.7%) specialties. Conclusion: Difficult airway predictors are common in surgical patients and disproportionately concentrated in specific high-risk subgroups, emphasizing the need for targeted airway assessment and enhanced perioperative preparedness.