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Risk factors for acute chest syndrome in children with sickle cell disease undergoing abdominal surgery

E R Kokoska1, K W West, D E Carney

  • 1Division of Pediatric Surgery, J.W. Riley Children's Hospital, Indianapolis, IN 46202, USA.

Journal of Pediatric Surgery
|June 9, 2004
PubMed

Insights

Younger children with sickle cell disease (SCD) undergoing abdominal surgery face higher risks of acute chest syndrome (ACS). Factors like blood loss and heat loss during procedures increase ACS risk, especially after splenectomy.

Area of Science:

  • Pediatric Surgery
  • Hematology
  • Critical Care Medicine

Background:

  • Acute chest syndrome (ACS) affects 15% to 20% of children with sickle cell disease (SCD).
  • Identifying risk factors for ACS in this population is crucial for improving outcomes.

Purpose of the Study:

  • To assess risk factors and morbidity associated with acute chest syndrome (ACS) in children with sickle cell disease (SCD) undergoing abdominal surgery.

Main Methods:

  • A retrospective review of children with SCD who underwent abdominal surgery over a 10-year period (1991-2003).
  • Surgical procedures included laparoscopic cholecystectomy, laparoscopic splenectomy, or both.
  • Outcomes, including ACS development and associated factors, were analyzed.

Main Results:

  • The incidence of ACS in this cohort was 6.6%, lower than previously reported.
  • Factors associated with ACS included younger age, lower weight, greater operative blood loss, and lower operating room temperature.
  • Splenectomy (laparoscopic or combined) was associated with an increased risk of ACS.

Conclusions:

  • Younger children with greater blood and heat loss during abdominal surgery are more susceptible to ACS.
  • Splenectomy appears to be an additional risk factor for ACS in children with SCD.
  • The lower observed ACS incidence may be attributed to aggressive preoperative transfusion or increased use of laparoscopy.
Abstract

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