Perioperative Management and Outcomes in Patients With Autism Spectrum Disorder: A Retrospective Cohort Study

Area of Science:

• Pediatric Anesthesiology
• Neurodevelopmental Disorders
• Surgical Outcomes

Background:

• Autism spectrum disorder (ASD) impacts communication and social interaction.
• Limited data exist on perioperative outcomes for children with ASD.
• This study investigates pain and other outcomes in children with and without ASD undergoing surgery.

Purpose of the Study:

• To compare postoperative pain scores in children with and without ASD.
• To evaluate other perioperative outcomes, including induction behavior and recovery.
• To identify potential areas for improving surgical care for children with ASD.

Main Methods:

• Retrospective cohort study of pediatric patients undergoing ambulatory surgery (2016-2021).
• ASD patients identified via ICD codes and compared to controls using inverse probability of treatment weighting.
• Primary outcome: maximum postanesthesia care unit (PACU) pain score; secondary outcomes: premedication, induction behavior, PACU opioid use, vomiting, delirium, and PACU length of stay.

Main Results:

• No significant difference in maximum PACU pain scores between ASD (n=335) and control (n=11,551) groups.
• Children with ASD had higher odds of difficult induction (11% vs 3.4%) despite similar premedication rates.
• Increased parental and child life specialist presence at induction was observed in the ASD group; no differences in other secondary outcomes.

Conclusions:

• Maximum PACU pain scores were similar in children with and without ASD.
• Children with ASD experienced more challenging inductions, suggesting a need for specialized approaches.
• Further research is needed to develop evidence-based interventions for optimizing perioperative care in pediatric ASD patients.