O'Leary James D, Janus Magdalena, Duku Eric, Wijeysundera Duminda N, To Teresa, Li Ping, Maynes Jason T, Crawford Mark W
Department of Anesthesia and Pain Medicine (J.D.O., J.T.M., M.W.C.) and Child Health Evaluative Sciences (T.T.), The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Anesthesia (J.D.O., D.N.W., J.T.M., M.W.C.) and Institute of Health Policy Management and Evaluation (D.N.W., T.T.), University of Toronto, Toronto, Ontario, Canada; The Offord Centre for Child Studies and Department of Psychiatry and Behavioural Neurosciences (M.J., E.D.), McMaster University, Hamilton, Ontario, Canada; Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada (D.N.W.); Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada (D.N.W.); and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada (D.N.W., T.T., P.L.).
Anesthesiology. 2016 Aug;125(2):272-9. doi: 10.1097/ALN.0000000000001200.
It is unclear whether exposure to surgery in early life has long-term adverse effects on child development. The authors aimed to investigate whether surgery in early childhood is associated with adverse effects on child development measured at primary school entry.
The authors conducted a population-based cohort study in Ontario, Canada, by linking provincial health administrative databases to children's developmental outcomes measured by the Early Development Instrument (EDI). From a cohort of 188,557 children, 28,366 children who underwent surgery before EDI completion (age 5 to 6 yr) were matched to 55,910 unexposed children. The primary outcome was early developmental vulnerability, defined as any domain of the EDI in the lowest tenth percentile of the population. Subgroup analyses were performed based on age at first surgery (less than 2 and greater than or equal to 2 yr) and frequency of surgery.
Early developmental vulnerability was increased in the exposed group (7,259/28,366; 25.6%) compared with the unexposed group (13,957/55,910; 25.0%), adjusted odds ratio, 1.05; 95% CI, 1.01 to 1.08. Children aged greater than or equal to 2 yr at the time of first surgery had increased odds of early developmental vulnerability compared with unexposed children (odds ratio, 1.05; 95% CI, 1.01 to 1.10), but children aged less than 2 yr at the time of first exposure were not at increased risk (odds ratio, 1.04; 95% CI, 0.98 to 1.10). There was no increase in odds of early developmental vulnerability with increasing frequency of exposure.
Children who undergo surgery before primary school age are at increased risk of early developmental vulnerability, but the magnitude of the difference between exposed and unexposed children is small.
早年接受手术是否会对儿童发育产生长期不良影响尚不清楚。作者旨在调查幼儿期手术是否与小学入学时所测量的儿童发育不良影响相关。
作者在加拿大安大略省进行了一项基于人群的队列研究，将省级卫生行政数据库与通过早期发育工具（EDI）测量的儿童发育结果相联系。在188,557名儿童队列中，将28,366名在EDI完成前（5至6岁）接受手术的儿童与55,910名未暴露儿童进行匹配。主要结局是早期发育易损性，定义为EDI中处于人群最低十分位数的任何领域。根据首次手术时的年龄（小于2岁和大于或等于2岁）和手术频率进行亚组分析。
与未暴露组（13,957/55,910；25.0%）相比，暴露组（7,259/28,366；25.6%）的早期发育易损性增加，调整后的优势比为1.05；95%置信区间为1.01至1.08。首次手术时年龄大于或等于2岁的儿童与未暴露儿童相比，早期发育易损性的优势比增加（优势比为1.05；95%置信区间为1.01至1.10），但首次暴露时年龄小于2岁的儿童风险未增加（优势比为1.04；95%置信区间为0.98至1.10）。随着暴露频率增加，早期发育易损性的优势比没有增加。
小学入学前接受手术的儿童早期发育易损性风险增加，但暴露儿童与未暴露儿童之间的差异幅度较小。
