Epilepsy Risk Associated With the Receipt of General Anesthesia Relative to Neuraxial Anesthesia: A Retrospective...

Area of Science:

• Anesthesiology
• Neurology
• Epidemiology

Background:

• General anesthesia may be linked to a higher risk of epilepsy than neuraxial anesthesia.
• Previous evidence suggests a potential association, necessitating further investigation.

Purpose of the Study:

• To estimate the risk of new-onset epilepsy following general anesthesia compared to neuraxial anesthesia.
• To analyze the temporal relationship between anesthesia type and epilepsy development.

Main Methods:

• Population-based retrospective cohort study using linked health administrative databases in Ontario, Canada.
• Included patients undergoing eligible surgeries with general or neuraxial anesthesia (2007-2015), followed for up to 5 years.
• Used inverse probability of treatment weighting and Fine-Gray subdistribution models to control for confounding and competing risks.

Main Results:

• 100,547 patients received general anesthesia and 76,644 received neuraxial anesthesia.
• General anesthesia showed a hazard ratio of 0.61 at time zero, but a time interaction HR of 1.36 indicated risk changed over time.
• A significantly increased risk of epilepsy associated with general anesthesia emerged after approximately 3 years.

Conclusions:

• The association between general anesthesia and increased epilepsy risk may manifest several years post-procedure.
• Findings may be influenced by unmeasured confounders, surgical procedure types, and post-anesthesia epilepsy risk factors.
• Future research should investigate effect modification by surgical procedures and control for post-anesthesia risk factors.