Abstract:Objective To investigate the risk factors for emergence agitation（EA）during the postoperative recovery period following open reduction of fractures in children，and to provide a scientific basis for the prevention and treatment of EA in children. Methods A retrospective study was conducted on 123 children who underwent elective open reduction of fractures at the Children'’s Hospital of Nanjing Medical University from October 2024 to December 2024. The Pediatric Anesthesia Emergence Delirium Scale（PAED）scores and Richmond Agitation and Sedation Scale（RASS）scores of the children were analyzed after they were admitted to the post -anesthesia care unit（PACU）postoperatively. Based on these scores，the children were grouped，and finally 100 cases were assigned to the EA-negative group and 23cases to the EA - positive group. Multivariate logistic regression analysis was used to identify the risk factors for EA in children after orthopedic surgery. Results There were statistically significant differences between the two groups in terms of month of age，modified Yale Preoperative Anxiety Scale（m-YPAS）scores，proportion of combined nerve block，proportion of sevoflurane used for anesthesia maintenance，and proportion of postoperative analgesia at the end of surgery（P<0.05）. Multivariate logistic regression analysis revealed that combined nerve block（OR=6.218，95%CI：1.410-27.417，P=0.016），sevoflurane used for anesthesia maintenance（OR=8.756，95%CI：1.391-55.102，P=0.021），and high m-YPAS scores（OR=1.094，95%CI：1.052-1.138，P <0.01）were independent risk factors for EA in children after open reduction of fractures. In contrast，postoperative analgesia at the end of surgery reduced the risk of EA in these children（OR=0.213，95%CI：0.046-0.976，P=0.046）. Conclusion Increased m-YPAS scores，anesthesia combined with nerve block，intraoperative sevoflurane maintenance，and no postoperative analgesia at the end of surgery are independent risk factors for EA in children after orthopedic surgery.