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Postanesthesia complications in pediatric patients with previous SARS-CoV-2 infection: A cohort study
Giuliana Geng-Ramos1, Jonathan Nelson1, Angela C Lee1
1Division of Anesthesiology, Pain and Perioperative Medicine, Children's National Hospital, The George Washington University, Washington, District of Columbia, USA.
Insights
Children with SARS-CoV-2 infection face higher postanesthesia complication risks, especially within 7 days of diagnosis. Cardiac risks may persist longer, necessitating further study on optimal surgery timing post-infection.
Area of Science:
- Pediatric Anesthesiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Children with SARS-CoV-2 infection have an elevated risk of postanesthesia complications.
- Limited data exists on the duration of this increased risk post-diagnosis.
Purpose of the Study:
- To investigate postanesthesia complications in children within 90 days of SARS-CoV-2 diagnosis.
- To determine the persistence of elevated complication risk after initial diagnosis.
Main Methods:
- A single-center, retrospective, case-control study was conducted.
- Pediatric patients with and without SARS-CoV-2 infection within 90 days of diagnosis were matched.
- Outcomes included postanesthesia complications, 30-day mortality, and hospital length of stay.
Main Results:
- Children tested positive for SARS-CoV-2 within 7 days of anesthesia had significantly higher postanesthesia complications and longer hospital stays.
- Anesthesia administered over 42 days post-diagnosis was associated with increased cardiac complications.
- No deaths were recorded within 30 days, and no increased hospital stay was observed for those diagnosed >8 days prior.
Conclusions:
- Postanesthesia complications are elevated in children undergoing anesthesia within 7 days of SARS-CoV-2 diagnosis.
- A potential for persistent cardiac risk exists beyond the acute infection period.
- Further research with larger cohorts is required to assess delayed complication risks and inform surgical timing decisions.
Background:
Children with SARS-CoV-2 infection are at increased risk for postanesthesia complications. There is minimal data regarding how long that elevated complication risk persists beyond initial SARS-CoV-2 diagnosis.
Aims:
We investigated postanesthesia complications in children with SARS-CoV-2 infection within 90 days of diagnosis.
Methods:
We completed a single-center, retrospective, case-control study of pediatric patients with confirmed SARS-CoV-2 infection within 90 days undergoing anesthesia between January 3-October 7, 2020. Each SARS-CoV-2 positive patient was matched 1:2 by age and type of procedure with a non-SARS-CoV-2 cohort. The primary outcome was the rate of all postanesthesia complications within 30 days of the procedure, defined as unplanned escalations of care within 48 h, cardiac, respiratory, thrombotic, and hemorrhagic events within 30 days. Secondary outcomes were 30-day mortality and hospital length of stay.
Results:
Of the 341 patients included, 114 patients were SARS-CoV-2 positive and 227 were SARS-CoV-2 negative. Patients with a positive test 0-7 days prior to anesthesia had an increased risk difference in all postanesthesia complications within 30 days (19.9, 95% CI [4.7, 35.1], p = .001) and increased risk difference in length of hospital stay (7.8, 95% CI [1.2, 14.4], p < .001). Patients who underwent anesthesia greater than 42 days from SARS-CoV-2 diagnosis had an increased risk difference in cardiac complications within 30 days (4.3, 95% CI [0.9, 10.0], p = .029). There was no increased hospital length of stay among SARS-CoV-2 positive patients diagnosed greater than 8 days before anesthetic. There were no deaths within 30 days of anesthetic.
Conclusions:
Postanesthesia complications are higher in children who undergo anesthesia within 7 days of SARS-CoV-2 diagnosis. Additional cardiac risk may persist beyond the immediate period of initial diagnosis. Larger samples are needed to further evaluate the risk of delayed postanesthesia complications and guide optimal timing of surgery.
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