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Intraoperative Bronchospasm and Future Asthma in Children: A Retrospective Matched Cohort Study
Anila B Elliott1,2, Elizabeth Jewell2, Yuan Yuan2
1C.S. Mott Children's Hospital, Ann Arbor, Michigan, USA.
Insights
Intraoperative bronchospasm in children undergoing surgery may indicate a higher risk of developing asthma later. This finding highlights the need for better collaboration between pediatric anesthesiologists and pediatricians for improved asthma detection.
Area of Science:
- Pediatric Anesthesiology
- Respiratory Medicine
- Clinical Pediatrics
Background:
- Asthma is a prevalent chronic childhood illness, with diagnosis challenges impacting quality of life and increasing morbidity.
- Children with asthma are susceptible to intraoperative bronchospasm, but a predictive link to future asthma diagnosis remains unclear.
Purpose of the Study:
- To investigate the association between intraoperative bronchospasm and the subsequent diagnosis of asthma in pediatric surgical patients.
- To explore risk factors and predictors for future asthma diagnosis in children.
Main Methods:
- Retrospective analysis of 44,284 children (aged 2-18) undergoing non-cardiac surgery (2014-2020).
- Data collection included demographics and peri-operative events, focusing on bronchospasm.
- Logistic regression and generalized estimating equations were used to assess associations.
Main Results:
- Intraoperative bronchospasm occurred in 0.3% of patients and was linked to a 2.29-fold increased risk of future asthma diagnosis (p=0.03).
- Male sex and younger age were also significant predictors of subsequent asthma.
- In a subgroup analysis, higher peak inspiratory pressure (PIP) during ventilation was associated with asthma.
Conclusions:
- Intraoperative bronchospasm serves as a potential indicator for increased future asthma risk in children.
- Enhanced collaboration between pediatric anesthesiologists and pediatricians is crucial for improving asthma detection, risk stratification, and patient care.
Background And Objectives:
Asthma is the most common chronic disease in children. Difficulty in diagnosis can lead to decreased quality of life and increased morbidity and mortality. Children with asthma have increased intraoperative bronchospasm; however, it is unclear whether intraoperative bronchospasm predicts future asthma. We explored intraoperative bronchospasm and subsequent asthma diagnosis.
Methods:
We retrospectively analyzed 44,284 children aged 2-18 years who underwent non-cardiac surgery under general anesthesia between 2014 and 2020. We collected demographic and peri-operative data, including the occurrence of bronchospasm. We then conducted a subgroup analysis of 35 770 patients that received positive pressure ventilation, using logistic regression to assess the relationship between bronchospasm and airway pressures. The association of bronchospasm and subsequent asthma diagnosis was estimated using generalized estimating equations.
Results:
Intraoperative bronchospasm occurred in 128 patients (0.3%) and was associated with increased risk of asthma (OR 2.29, 95% CI 1.10-4.74, p = 0.03). Asthma was diagnosed in 1238 patients (2.8%); 8 had intraoperative bronchospasm (8 of 1238, 0.7%). After adjustment for confounders, male sex (OR 1.57, 95% CI 1.39-1.76, p < 0.001) and younger age (OR 0.96, 95% CI 0.94-0.97, p < 0.001) were also associated with future asthma diagnosis. In the subgroup analysis, Mean PIP (OR 1.50, 95% CI 1.30-1.74, p < 0.001) was associated with asthma.
Conclusions:
This study shows intraoperative bronchospasm is associated with an increased risk of future asthma in children. Enhanced collaboration between pediatric anesthesiologists and pediatricians, and further research, is essential to improve asthma detection, risk stratification, and overall care for pediatric patients.
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