Perioperative Complications in Multispecialty Surgical Care for Patients With Trisomy 21: A Single Center...

The medical comorbidities associated with trisomy 21 (T21) often necessitate multiple surgical and imaging procedures requiring general anesthesia, with perioperative complications occurring at a higher frequency than their age-matched peers. Combining multiple procedures by unrelated specialists under a single anesthetic is often suggested as a method to reduce anesthetic risks during induction, airway manipulation and emergence, in addition to potentially decreasing health care costs and time burdens on patients and families, but the safety advantage of this strategy has not been demonstrated.

To evaluate the association of multispecialty case strategies with perioperative safety events in children with T21.

At Children's Wisconsin, we performed 219 626 anesthesia cases in 120 299 patients over a span of 9.6 years, compared to 3873 cases in 995 patients with T21. Of this cohort, 2871 cases were single specialty in nature while 1002 (17.5%) cases were multispecialty. Compared to the whole anesthesia population, the T21 cohort had a notably higher likelihood of multiple anesthetics per patient (OR = 8.02 [95% CI 7.11-9.04] p < 0.001), multispecialty care (OR = 3.95 [95% CI 3.6-4.3] p < 0.001), and risk of perioperative safety events (OR = 5.65 [95% CI 4.51-7.08] p < 0.001). The T21 cohort had lower age and weight, higher ASA-PS, more organ-based pathology, longer anesthesia case times, more cases, and higher multispecialty exposure per case. Detailed demographic comparison of the T21 cohort to the anesthesia population is shown in Table S2. Multivariable logistic regression identified independent risk factors associated with perioperative events as ASA-PS 4 (OR = 4.5 [95% CI 1.4-14.5]) or 5 (OR = 85.5 [95% CI 22.8-320.3]), Black or African American race (OR = 1.98 [95% CI 1.2-3.3]), anesthesia time (OR = 1.22 [95% CI 1.1-1.3]), and multispecialty case (OR = 2.6 [95% CI 1.6-4.3]); however, there was no increased risk with number of anesthetics per patient. No attempts were made to evaluate whether the families perceived benefit of either practice.

Multispecialty care is a highly utilized method of providing care for children with T21 within our institution, often used to ease the scheduling burden and risk of these children and families. Understanding the risk associated with this practice by parents and care providers may lead to a more thoughtful scheduling practice. With this understanding, patients in need of multispecialty care may benefit by either considering a single specialty case or limit multispecialty scheduling to a 4-h duration.