Saynhalath Rita, Sanford Ethan L, Kato Meredith A, Staffa Steven J, Zurakowski David, Meier Petra M, Alex Gijo A, Fuller Clinton L, Rossmann Beel Elizabeth N, Chhabada Surendrasingh, Poppino Kiley F, Szmuk Peter, Matava Clyde T, Efune Proshad N
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.
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.
Br J Anaesth. 2025 Feb;134(2):441-452. doi: 10.1016/j.bja.2024.10.005. Epub 2024 Nov 16.
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.
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.
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.
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.
感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的儿童在接受麻醉时发生严重不良事件的发生率尚未明确。我们研究了SARS-CoV-2感染与儿童围手术期严重不良事件之间的关系。
这项多中心（21家北美机构）回顾性队列研究纳入了年龄小于18岁、美国麻醉医师协会身体状况分级（ASA PS）为1-4级且感染非重症SARS-CoV-2的儿童，这些儿童于2020年4月1日至2021年3月31日期间接受全身麻醉。主要结局是麻醉后7天内严重围手术期不良事件（因呼吸支持升级入住重症监护病房、急性呼吸窘迫综合征、术后肺炎、心血管骤停、体外生命支持和死亡）的发生率，采用多变量分析并通过倾向评分进行治疗权重的逆概率分析。倾向评分混合效应模型纳入了预先选定的变量。治疗权重的逆概率用于保留所有数据，同时在测量的混杂因素上平衡暴露组。
我们将麻醉前10天内SARS-CoV-2检测呈阳性的1138例患者与3396例未感染对照进行匹配。该队列包括56.6%（2568/4534）的男性患者、69.9%（2839/4060）的白人患者以及63.5%（2879/4533）的ASA PS 1-2级患者。普通外科手术病例占队列的38.4%（1739/4534），其次是骨科手术，占12.6%（573/4534），耳鼻喉科手术占8.2%（371/4534）。在4534例患者的总体样本中，52例发生严重不良事件（0.01%）。感染SARS-CoV-2的儿童发生至少一项严重不良事件的风险更高（25/1138 [2.20%] 对比未感染儿童中的27/3396 [0.80%]；校正优势比2.34；95%置信区间1.25-4.39）。感染SARS-CoV-2的儿童中无人发生心脏骤停、需要体外生命支持或死亡。
在迄今为止接受全身麻醉的儿科患者最大队列中，SARS-CoV-2感染与围手术期严重不良事件相关，但感染队列中无儿童死亡。
