Postanesthesia Complications in Pediatric Patients with Previous SARS-CoV-2 Infection: A Cohort Study

Authors

Giuliana Geng-Ramos, Division of Anesthesiology, Pain and Perioperative Medicine, Children's National Hospital, The George Washington University, Washington, USA.
Jonathan Nelson, Division of Anesthesiology, Pain and Perioperative Medicine, Children's National Hospital, The George Washington University, Washington, USA.
Angela C. Lee, Division of Anesthesiology, Pain and Perioperative Medicine, Children's National Hospital, The George Washington University, Washington, USA.
Nina Deutsch, Division of Anesthesiology, Pain and Perioperative Medicine, Children's National Hospital, The George Washington University, Washington, USA.
Chaitanya Challa, Division of Anesthesiology, Pain and Perioperative Medicine, Children's National Hospital, The George Washington University, Washington, USA.
Sophie Pestieau, Division of Anesthesiology, Pain and Perioperative Medicine, Children's National Hospital, The George Washington University, Washington, USA.
Md Sohel Rana, Joseph E. Robert Jr, Center for Surgical Care, Children's National Hospital, Washington, DC, USA.
Mark Hubbard, Division of Anesthesiology, Pain and Perioperative Medicine, Children's National Hospital, The George Washington University, Washington, USA.
Jessica A. Cronin, Division of Anesthesiology, Pain and Perioperative Medicine, Children's National Hospital, The George Washington University, Washington, USA.

Document Type

Journal Article

Publication Date

10-31-2022

Journal

Paediatric anaesthesia

DOI

10.1111/pan.14585

Keywords

COVID-19; SARS-CoV-2; complications; postanesthesia

Abstract

BACKGROUND: Children with SARS-CoV-2 infection are at increased risk for postanesthesia complications. There is minimal data regarding how long that elevated complication risk persists beyond initial SARS-CoV-2 diagnosis. AIMS: We investigated postanesthesia complications in children with SARS-CoV-2 infection within 90 days of diagnosis. METHODS: We completed a single-center, retrospective, case-control study of pediatric patients with confirmed SARS-CoV-2 infection within 90 days undergoing anesthesia between January 3- October 7, 2020. Each SARS-CoV-2 positive patient was matched 1:2 by age and type of procedure with a non-SARS-CoV-2 cohort. The primary outcome was the rate of all postanesthesia complications within 30 days of the procedure, defined as unplanned escalations of care within 48 hours, cardiac, respiratory, thrombotic, and hemorrhagic events within 30 days. Secondary outcomes were 30-day mortality and hospital length of stay. RESULTS: Of the 341 patients included, 114 patients were SARS-CoV-2 positive and 227 were SARS-CoV-2 negative. Patients with a positive test 0-7 days prior to anesthesia had an increased risk difference in all postanesthesia complications within 30 days (19.9, 95% CI [4.7, 35.1], p=0.001) and increased risk difference in length of hospital stay (7.8, 95% CI [1.2, 14.4], p <0.001). Patients who underwent anesthesia greater than 42 days from SARS-CoV-2 diagnosis had an increased risk difference in cardiac complications within 30 days (4.3, 95% CI [0.9, 10.0], p=0.029). There was no increased hospital length of stay among SARS-CoV-2 positive patients diagnosed greater than eight days before anesthetic. There were no deaths within 30 days of anesthetic. CONCLUSIONS: Postanesthesia complications are higher in children who undergo anesthesia within seven days of SARS-CoV-2 diagnosis. Additional cardiac risk may persist beyond the immediate period of initial diagnosis. Larger samples are needed to further evaluate the risk of delayed postanesthesia complications and guide optimal timing of surgery.

APA Citation

Geng-Ramos, Giuliana; Nelson, Jonathan; Lee, Angela C.; Deutsch, Nina; Challa, Chaitanya; Pestieau, Sophie; Rana, Md Sohel; Hubbard, Mark; and Cronin, Jessica A., "Postanesthesia Complications in Pediatric Patients with Previous SARS-CoV-2 Infection: A Cohort Study" (2022). GW Authored Works. Paper 1722.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/1722

Department

Anesthesiology and Critical Care Medicine