Perioperative Complications in Children with Down Syndrome: A Single Center Retrospective Analysis-Original Clinical...

Background/Objectives: Down syndrome (DS) is the most common chromosomal abnormality in live births in the United States. Children with DS often require anesthesia for surgery or diagnostic imaging in their lives. These children present a unique perioperative risk profile due to a combination of anatomic and physiological alterations, along with associated comorbid conditions. There are limited studies on the perioperative outcomes of children with DS. This retrospective study assesses perioperative complications in pediatric patients with DS undergoing non-cardiac surgery or diagnostic imaging under anesthesia at a single tertiary pediatric hospital. Methods: The electronic medical record at a tertiary pediatric hospital was queried for children with DS who received anesthesia for non-cardiac surgery or diagnostic imaging from May 2016 to April 2021. The primary outcomes were complications defined as readmission, reoperation, or unexpected respiratory, cardiovascular, neurologic, surgical, or gastrointestinal issues. Exclusion criteria were cardiac surgery, age > 18 years, and records with incomplete or missing data. Results: A total of 1713 anesthetic records from 711 unique patients over five years were included in the final analysis. The study found a low overall complication rate (2.98%), with respiratory events being the most common (43.1%). While most complications are short term and resolved with treatment and time; there were also several severe, life-threatening complications. Increased procedural complexity, multiple procedures, and increased procedure duration were associated with higher complication rates, whereas patient age, sex, weight, and case urgency were not associated with higher complication rates. Conclusions: Children with DS often have comorbid conditions and require multiple life-improving surgeries. Our study found the perioperative complication rate for children with Down syndrome receiving anesthesia for non-cardiac surgery or diagnostic imaging is low, comparable to the general pediatric population. The findings indicate that anesthesia is well tolerated by children with DS. However, given patients' unique anatomic and physiological differences, careful perioperative risk assessment and planning is essential. Clinical Implications: (a) What is already known about the topic: Pediatric patients with DS often require anesthesia for surgical procedures or medical imaging. They have anatomic and physiological alterations and comorbid conditions that may influence perioperative risk. (b) What new information this study adds: In a retrospective study at a tertiary pediatric hospital, patients with DS were found to have a low overall complication rate after anesthesia for non-cardiac surgery or diagnostic imaging. Increased procedural complexity, multiple procedures, and increased procedure duration were associated with higher complication rates.