Multicentre analysis of severe perioperative adverse events in children undergoing surgery who were infected with SARS-CoV-2: a propensity score-adjusted analysis

Rita Saynhalath; Ethan L Sanford; Meredith A Kato; Steven J Staffa; David Zurakowski; Petra M Meier; Gijo A Alex; Clinton L Fuller; Elizabeth N Rossmann Beel; Surendrasingh Chhabada; Kiley F Poppino; Peter Szmuk; Clyde T Matava; Proshad N Efune; Pediatric Anesthesia COVID-19 Collaborative

doi:10.1016/j.bja.2024.10.005

Multicentre analysis of severe perioperative adverse events in children undergoing surgery who were infected with SARS-CoV-2: a propensity score-adjusted analysis

Br J Anaesth. 2024 Nov 15:S0007-0912(24)00607-X. doi: 10.1016/j.bja.2024.10.005. Online ahead of print.

Authors

Collaborators

Pediatric Anesthesia COVID-19 Collaborative:
John L Adams⁹, Victoria A Bradford¹⁰, Alyssa B Brzenski¹¹, Anjali A Chacko¹², Denise Chang¹³, Ingrid Chitiva-Martinez¹⁴, Lynn R Correll¹⁵, Jessica A Cronin¹⁶, Bradley Curtis¹⁷, Guy De L Dear¹⁸, Zachary H¹⁹, Marla Ferschl¹³, Jake Fisher²⁰, Giuliana Geng-Ramos¹⁶, Chris D Glover²¹, Olivia C Iheme²², Andrew Infosino¹³, Lisa K Lee²³, Catherine G McCarthy¹¹, Ann S Ng²¹, Niroop R Ravula²⁴, Srijaya K Reddy¹⁷, Erin L Renze²⁵, David A Roberts¹⁷, Nickhil A Rugnath²⁶, Rebecca Schroeder²⁷, Michelle M Sheth⁹, Codruta N Soneru²⁸, Kunal Sualy²⁹, Brad M Taicher²⁷, Sarah Tariq³⁰, Ellen Y Wang³¹, Joseph Weethee³², Robert T Wilder³³, Nicole Zanolli³⁴

Affiliations

¹ Department of Anesthesiology and Pain Management, University of Texas Southwestern and Children's Health, Dallas, TX, USA; Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA. Electronic address: Rita.Saynhalath@UTSouthwestern.edu.
² Department of Anesthesiology and Pain Management, University of Texas Southwestern and Children's Health, Dallas, TX, USA; Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA.
³ APOM Department of Anesthesiology, Oregon Health & Science University, Portland, OR, USA.
⁴ Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
⁵ Department of Anesthesiology and Pain Management, University of Texas Southwestern and Children's Health, Dallas, TX, USA.
⁶ Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Houston, TX, USA.
⁷ Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA; Department of Integrated Surgical Care, Division of Pediatric Anesthesiology, Children's Institute, Cleveland Clinic, Cleveland, OH, USA.
⁸ Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, ON, Canada.
⁹ Department of Anesthesiology, University of Mississippi Medical Center, Jackson, MS, USA.
¹⁰ Department of Anesthesiology, Children's Hospital of Michigan, Detroit, MI, USA.
¹¹ University of California San Diego, Rady Children's Hospital, San Diego, CA, USA.
¹² Department of Anesthesiology, Yale New Haven Hospital, New Haven, CT, USA.
¹³ Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA, USA.
¹⁴ Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada.
¹⁵ Department of Pediatric Anesthesiology, British Columbia Children's Hospital, Vancouver, Canada; Department of Anesthesia, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada.
¹⁶ Department of Anesthesiology, Pain, and Perioperative Medicine, Children's National Hospital, Washington, DC, USA.
¹⁷ Department of Anesthesiology, Division of Pediatric Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA.
¹⁸ Department of Anesthesiology, Duke University, Durham, NC, USA.
¹⁹ Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA.
²⁰ UC Davis Children's Hospital, UC Davis Medical Center, Sacramento, CA, USA.
²¹ Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Houston, TX, USA; Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA.
²² University of Texas Southwestern Medical School, Dallas, TX, USA.
²³ Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles, Los Angeles, CA, USA.
²⁴ Department of Anesthesiology and Pain Medicine, UC Davis Health, Sacramento, CA, USA.
²⁵ Department of Anesthesiology, Children's Nebraska, Omaha, NE, USA.
²⁶ School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
²⁷ Department of Anesthesiology, Duke University Hospital, Durham, NC, USA.
²⁸ Department of Anesthesiology and Critical Care, University of New Mexico, Albuquerque, NM, USA.
²⁹ Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA; Department of Anesthesiology, Children's Nebraska, Omaha, NE, USA.
³⁰ Department of Anesthesiology, Texas Scottish Rite Hospital for Children, Frisco, TX, USA.
³¹ Department of Anesthesiology, Pain and Perioperative Medicine, Stanford University, Palo Alto, CA, USA.
³² Department of Anesthesia, Cincinnati Children's Hospital, Cincinnati, OH, USA.
³³ Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Alix School of Medicine, Rochester, Rochester, MN, USA.
³⁴ Department of Anesthesiology and Critical Care, Duke University School of Medicine, Durham, NC, USA.

PMID: 39550319
DOI: 10.1016/j.bja.2024.10.005

Abstract

Background: The incidence of severe adverse events in children with SARS-CoV-2 undergoing anaesthesia has not been well established. We examined the relationship between SARS-CoV-2 infection and severe perioperative adverse events in children.

Methods: This multicentre (21 North American institutions), retrospective cohort study included children <18 years old, with American Society of Anesthesiologists physical status (ASA PS) of 1-4 and non-severe SARS-CoV-2, who underwent general anaesthesia between April 1, 2020, and March 31, 2021. The primary outcome was the incidence of severe perioperative adverse events (admission to the intensive care unit for escalation of respiratory support, acute respiratory distress syndrome, postoperative pneumonia, cardiovascular arrest, extracorporeal life support, and death) within 7 days of the anaesthetic, assessed using multivariable analysis with inverse probability of treatment weighting by the propensity score. A propensity score mixed-effects model included variables selected a priori. Inverse probability of treatment weighting was used to retain all data while balancing exposure groups on measured confounders.

Results: We matched 1138 patients with SARS-CoV-2 positive testing within 10 days of the anaesthetic to 3396 non-infected controls. The cohort included 56.6% (2568/4534) male patients, 69.9% (2839/4060) White patients, and 63.5% (2879/4533) ASA PS 1-2 patients. General surgery cases comprised 38.4% (1739/4534) of the cohort, followed by orthopaedic surgery at 12.6% (573/4534) and ear, nose, and throat surgery at 8.2% (371/4534). In the overall sample of 4534 patients, 52 had a severe adverse event (0.01%). Children with SARS-CoV-2 had a higher risk of at least one severe adverse event (25/1138 [2.20%] vs 27/3396 [0.80%] in those non-infected; adjusted odds ratio 2.34; 95% confidence interval 1.25-4.39). None of the children with SARS-CoV-2 had a cardiac arrest, required extracorporeal life support, or died.

Conclusions: In the largest cohort to date of paediatric patients undergoing general anaesthesia, SARS-CoV-2 infection was associated with severe perioperative adverse events, but no children in the infected cohort died.

Keywords: SARS-CoV-2; infectious disease; paediatric anaesthesia; perioperative outcomes; severe adverse events.