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Academic performance in adolescence after inguinal hernia repair in infancy: a nationwide cohort study
Tom G Hansen1, Jacob K Pedersen, Steen W Henneberg
1Department of Anesthesia and Intensive Care, Odense University Hospital, Denmark. tomghansen@dadlnet.dk
Insights
Infants undergoing surgery and anesthesia for inguinal hernia repair showed no significant difference in academic performance later in life. However, the study noted a higher rate of test score nonattainment in this group.
Area of Science:
- Pediatric Anesthesiology
- Developmental Neuroscience
- Pediatric Surgery
Background:
- Animal studies suggest general anesthetics may harm the developing brain.
- Human data on anesthetic effects on infant neurodevelopment are limited.
- This study investigates anesthesia exposure for infant inguinal hernia repair and academic outcomes.
Purpose of the Study:
- To examine the association between infant inguinal hernia repair under anesthesia and subsequent academic performance.
- To determine if early-life anesthesia exposure impacts long-term cognitive function.
Main Methods:
- Danish birth cohorts (1986-1990) were used.
- Children undergoing inguinal hernia repair were compared to a matched population sample.
- Academic performance was assessed via ninth-grade test scores, adjusting for confounders.
Main Results:
- No statistically significant difference in average ninth-grade test scores was found between groups after adjustment.
- However, children who had inguinal hernia repair showed a higher odds ratio for test score nonattainment (1.18).
- Excluding children with other congenital malformations attenuated the nonattainment odds ratio (1.13).
Conclusions:
- A single, brief anesthetic exposure for infant hernia repair did not reduce academic performance at ages 15-16.
- The increased rate of test score nonattainment suggests potential developmental disadvantages in a subgroup of these children.
- Findings are specific to the ethnically and socioeconomically homogeneous Danish population.
Background:
Although animal studies have indicated that general anesthetics may result in widespread apoptotic neurodegeneration and neurocognitive impairment in the developing brain, results from human studies are scarce. We investigated the association between exposure to surgery and anesthesia for inguinal hernia repair in infancy and subsequent academic performance.
Methods:
Using Danish birth cohorts from 1986-1990, we compared the academic performance of all children who had undergone inguinal hernia repair in infancy to a randomly selected, age-matched 5% population sample. Primary analysis compared average test scores at ninth grade adjusting for sex, birth weight, and paternal and maternal age and education. Secondary analysis compared the proportions of children not attaining test scores between the two groups.
Results:
From 1986-1990 in Denmark, 2,689 children underwent inguinal hernia repair in infancy. A randomly selected, age-matched 5% population sample consists of 14,575 individuals. Although the exposure group performed worse than the control group (average score 0.26 lower; 95% CI, 0.21-0.31), after adjusting for known confounders, no statistically significant difference (-0.04; 95% CI, -0.09 to 0.01) between the exposure and control groups could be demonstrated. However, the odds ratio for test score nonattainment associated with inguinal hernia repair was 1.18 (95% CI, 1.04-1.35). Excluding from analyses children with other congenital malformations, the difference in mean test scores remained nearly unchanged (0.05; 95% CI, 0.00-0.11). In addition, the increased proportion of test score nonattainment within the exposure group was attenuated (odds ratio = 1.13; 95% CI, 0.98-1.31).
Conclusion:
In the ethnically and socioeconomically homogeneous Danish population, we found no evidence that a single, relatively brief anesthetic exposure in connection with hernia repair in infancy reduced academic performance at age 15 or 16 yr after adjusting for known confounding factors. However, the higher test score nonattainment rate among the hernia group could suggest that a subgroup of these children are developmentally disadvantaged compared with the background population.
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