小儿患者术前麻醉并发症：一项 SARS-CoV-2 感染既往史的队列研究。
Postanesthesia complications in pediatric patients with previous SARS-CoV-2 infection: A cohort study.
机构信息
Division of Anesthesiology, Pain and Perioperative Medicine, Children's National Hospital, The George Washington University, Washington, District of Columbia, USA.
Joseph E. Robert Jr, Center for Surgical Care, Children's National Hospital, Washington, District of Columbia, USA.
出版信息
Paediatr Anaesth. 2023 Jan;33(1):79-85. doi: 10.1111/pan.14585. Epub 2022 Nov 7.
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.
背景
感染 SARS-CoV-2 的儿童在麻醉后出现并发症的风险增加。关于 SARS-CoV-2 诊断后这种风险持续时间延长的数据很少。
目的
我们调查了 SARS-CoV-2 感染儿童在诊断后 90 天内的麻醉后并发症。
方法
我们进行了一项单中心、回顾性、病例对照研究，纳入了 2020 年 1 月 3 日至 10 月 7 日期间在 SARS-CoV-2 感染后 90 天内接受麻醉的儿科患者。每个 SARS-CoV-2 阳性患者均按年龄和手术类型与非 SARS-CoV-2 队列匹配 1:2。主要结局为术后 30 天内所有麻醉后并发症的发生率，定义为 48 小时内计划外治疗升级、30 天内心脏、呼吸、血栓和出血事件。次要结局为 30 天死亡率和住院时间。
结果
341 例患者中，114 例 SARS-CoV-2 阳性，227 例 SARS-CoV-2 阴性。麻醉前 0-7 天检测呈阳性的患者，术后 30 天内所有麻醉后并发症的风险差异增加（19.9，95%CI[4.7，35.1]，p=0.001），住院时间的风险差异增加（7.8，95%CI[1.2，14.4]，p<0.001）。SARS-CoV-2 诊断后 42 天以上接受麻醉的患者，30 天内心脏并发症的风险差异增加（4.3，95%CI[0.9，10.0]，p=0.029）。在 SARS-CoV-2 阳性患者中，麻醉前 8 天以上诊断的患者，住院时间没有延长。麻醉后 30 天内无死亡。
结论
在 SARS-CoV-2 诊断后 7 天内接受麻醉的儿童，麻醉后并发症发生率更高。在初始诊断后的即刻时期之外，可能会持续存在额外的心脏风险。需要更大的样本量来进一步评估延迟麻醉后并发症的风险，并指导手术的最佳时机。
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