A Population-based Study Evaluating the Association between Surgery in Early Life and Child Development at Primary

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James D O'Leary1, Magdalena Janus, Eric Duku

  • 1Department of Anesthesia and Pain Medicine (J.D.O., J.T.M., M.W.C.) and Child Health Evaluative Sciences (T.T.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Anesthesia (J.D.O., D.N.W., J.T.M., M.W.C.) and Institute of Health Policy Management and Evaluation (D.N.W., T.T.), University of Toronto, Toronto, Ontario, Canada; The Offord Centre for Child Studies and Department of Psychiatry and Behavioural Neurosciences (M.J., E.D.), McMaster University, Hamilton, Ontario, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada (D.N.W.); Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada (D.N.W.); and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (D.N.W., T.T., P.L.).

Anesthesiology
|July 20, 2016
PubMed

Insights

Children undergoing early childhood surgery show a small increase in developmental vulnerability by primary school age. This risk is associated with surgery at age two or older, but not younger.

Area of Science:

  • Pediatric surgery
  • Child development research
  • Public health and epidemiology

Background:

  • Long-term effects of early-life surgery on child development remain unclear.
  • Investigating the association between childhood surgery and developmental outcomes at primary school entry.

Purpose of the Study:

  • To determine if surgery in early childhood is linked to adverse developmental effects.
  • To assess developmental vulnerability using the Early Development Instrument (EDI).

Main Methods:

  • Population-based cohort study in Ontario, Canada.
  • Linked health administrative data with EDI outcomes for 188,557 children.
  • Matched 28,366 surgically exposed children with 55,910 unexposed children.

Main Results:

  • Increased odds of early developmental vulnerability in surgically exposed children (25.6% vs. 25.0%).
  • Higher risk observed for children undergoing first surgery at age 2+ years (OR 1.05).
  • No increased risk for surgery before age 2 or with increased surgery frequency.

Conclusions:

  • Surgery before primary school age is associated with a slight increase in developmental vulnerability.
  • The observed increase in developmental risk is small.
  • Age at first surgery influences developmental outcomes.
Abstract

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