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Surgical procedures and outcomes among children with sickle cell disease
Omar Hyder1, Myron Yaster, Brian T Bateman
1From the Departments of *Surgery and †Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD; ‡Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital; and §Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
Insights
Pediatric sickle cell disease patients undergo common surgeries like cholecystectomy and tonsillectomy, accounting for a small but significant portion of hospitalizations. Acute chest syndrome is a frequent complication of elective surgery in this group.
Area of Science:
- Pediatric Surgery
- Hematology
- Epidemiology
Background:
- Limited epidemiological data exist for pediatric sickle cell disease patients undergoing surgery.
- This study addresses the need for current data on surgical procedures and outcomes in this population.
Purpose of the Study:
- To estimate population characteristics, surgical procedures, and perioperative outcomes in pediatric patients with sickle cell disease.
- To identify the most common surgical procedures performed in children with sickle cell disease.
Main Methods:
- Utilized the Nationwide Inpatient Sample Database from 2000 to 2010.
- Included patients under 18 years with a sickle cell disease diagnosis who underwent surgery.
- Abstracted surgical procedures using Clinical Classifications Software and ICD-9-CM codes.
Main Results:
- Surgical procedures accounted for 3.6% of pediatric sickle cell disease hospital discharges (2000-2010).
- Most common surgeries included cholecystectomy, tonsillectomy/adenoidectomy, and splenectomy.
- Acute chest syndrome occurred in 3.08% of patients undergoing elective surgery; stroke and death were rare.
Conclusions:
- Cholecystectomy, tonsillectomy, splenectomy, hernia repair, and appendectomy are significant procedures in pediatric sickle cell disease admissions.
- Acute chest syndrome is a notable complication of elective surgery, while severe outcomes like stroke and death are infrequent.
Background:
Although children with sickle cell disease often undergo surgery, there are limited current epidemiological data for this pediatric population. We performed a database analysis to estimate population characteristics, surgical procedures, and perioperative outcomes in this population.
Methods:
We queried the Nationwide Inpatient Sample Database from 2000 to 2010 for discharges pertaining to patients <18 years of age having a diagnosis of sickle cell disease who underwent 1 or more surgical procedures during that admission. We abstracted surgical procedures using the Clinical Classifications Software procedure codes and the ICD-9-CM procedure codes. We described characteristics of patients undergoing the 6 most common procedures.
Results:
During 2000 to 2010, 3.6 % (SE 0.12) of individual hospital discharges were of children with sickle cell disease who had undergone surgical procedures. The most frequent surgical procedures were cholecystectomy (1.47% [0.08]), tonsillectomy/adenoidectomy (0.81% [0.06]), splenectomy (0.62% [0.06]), repair of umbilical hernia (0.19% [0.02]), and appendectomy (0.17% [0.02]). Acute chest syndrome was recorded among 3.08% (0.60) of patients undergoing elective surgery. The incidence of stroke was 0.20% (0.11); death was reported in <11 patients (<0.20%).
Conclusion:
Surgical procedures such as cholecystectomy, tonsillectomy, splenectomy, hernia repair, and appendectomy account for a small but significant proportion of hospital admissions in children with sickle cell disease. Acute chest syndrome is among the most common complications of elective surgery, while stroke and death are rare.
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