Postanesthesia complications in pediatric patients with previous SARS-CoV-2 infection: A cohort study

Giuliana Geng-Ramos; Jonathan Nelson; Angela C Lee; Nina Deutsch; Chaitanya Challa; Sophie Pestieau; Md Sohel Rana; Mark Hubbard; Jessica A Cronin

doi:10.1111/pan.14585

Postanesthesia complications in pediatric patients with previous SARS-CoV-2 infection: A cohort study

Paediatr Anaesth. 2023 Jan;33(1):79-85. doi: 10.1111/pan.14585. Epub 2022 Nov 7.

Authors

Giuliana Geng-Ramos¹, Jonathan Nelson¹, Angela C Lee¹, Nina Deutsch¹, Chaitanya Challa¹, Sophie Pestieau¹, Md Sohel Rana², Mark Hubbard¹, Jessica A Cronin¹

Affiliations

¹ Division of Anesthesiology, Pain and Perioperative Medicine, Children's National Hospital, The George Washington University, Washington, District of Columbia, USA.
² Joseph E. Robert Jr, Center for Surgical Care, Children's National Hospital, Washington, District of Columbia, USA.

Abstract

Background: Children with SARS-CoV-2 infection are at increased risk for postanesthesia complications. There is minimal data regarding how long that elevated complication risk persists beyond initial SARS-CoV-2 diagnosis.

Aims: We investigated postanesthesia complications in children with SARS-CoV-2 infection within 90 days of diagnosis.

Methods: We completed a single-center, retrospective, case-control study of pediatric patients with confirmed SARS-CoV-2 infection within 90 days undergoing anesthesia between January 3-October 7, 2020. Each SARS-CoV-2 positive patient was matched 1:2 by age and type of procedure with a non-SARS-CoV-2 cohort. The primary outcome was the rate of all postanesthesia complications within 30 days of the procedure, defined as unplanned escalations of care within 48 h, cardiac, respiratory, thrombotic, and hemorrhagic events within 30 days. Secondary outcomes were 30-day mortality and hospital length of stay.

Results: Of the 341 patients included, 114 patients were SARS-CoV-2 positive and 227 were SARS-CoV-2 negative. Patients with a positive test 0-7 days prior to anesthesia had an increased risk difference in all postanesthesia complications within 30 days (19.9, 95% CI [4.7, 35.1], p = .001) and increased risk difference in length of hospital stay (7.8, 95% CI [1.2, 14.4], p < .001). Patients who underwent anesthesia greater than 42 days from SARS-CoV-2 diagnosis had an increased risk difference in cardiac complications within 30 days (4.3, 95% CI [0.9, 10.0], p = .029). There was no increased hospital length of stay among SARS-CoV-2 positive patients diagnosed greater than 8 days before anesthetic. There were no deaths within 30 days of anesthetic.

Conclusions: Postanesthesia complications are higher in children who undergo anesthesia within 7 days of SARS-CoV-2 diagnosis. Additional cardiac risk may persist beyond the immediate period of initial diagnosis. Larger samples are needed to further evaluate the risk of delayed postanesthesia complications and guide optimal timing of surgery.

Keywords: COVID-19; SARS-CoV-2; complications; postanesthesia.

MeSH terms

COVID-19 Testing
COVID-19* / complications
Case-Control Studies
Child
Cohort Studies
Humans
Retrospective Studies
SARS-CoV-2