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