Karthic Anitra, Orgil Zandantsetseg, Kalsotra Sidhant, Cugino Michelle, Durban Adelei, Tram Nguyen K, Rice-Weimer Julie, Willer Brittany L, D'Mello Ajay, Tobias Joseph D, Olbrecht Vanessa A
Department of Anesthesiology, Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.
The Ohio State University College of Medicine, Columbus, Ohio, USA.
Paediatr Anaesth. 2025 Mar;35(3):239-248. doi: 10.1111/pan.15051. Epub 2024 Dec 5.
COVID-19 increases anesthetic risk in children, but understanding of complication differences by symptom presence and severity is limited. We hypothesized that symptomatic COVID-19+ children, especially with lower respiratory symptoms, would have higher perioperative complications than asymptomatic patients and that complications would be higher in all patients diagnosed < 6 days before anesthesia.
This single-center, retrospective cohort study reviewed records of children < 18 years old undergoing surgery with general anesthesia from March 1, 2020, to March 1, 2022, who tested COVID-19+. A total of 225 patients who tested positive ≤ 10 days before anesthesia were analyzed for the primary outcome, and an additional 298 patients who tested positive ≤ 21 days before anesthesia were analyzed for secondary outcomes. Data on demographics, comorbidities, vaccination, preoperative and perioperative care, complications, and mortality were collected. Primary outcome analysis used univariate regression; secondary outcome analysis used analysis of variance.
Primary Outcome: Symptomatic patients were more likely to experience postoperative respiratory complications (OR: 3.53, 1.18-10.6, p = 0.024), require postoperative medications (OR: 7.64, 2.29-25.51, p = 0.001), and require postoperative oxygen support (OR: 2.62, 1.19-5.79, p = 0.017) versus asymptomatic patients. Those with upper respiratory symptoms were less likely to require postoperative medications (OR: 0.1, 0.01-0.89, p = 0.039) and oxygen support (OR: 0.08, 0.01-0.45, p = 0.004) versus those with lower respiratory symptoms.
Patients testing COVID-19+ < 6 days before anesthesia had longer PACU stays (p < 0.001) and more postoperative respiratory complications (p = 0.001), medication use (p = 0.038), and oxygen use (p = 0.002) versus other groups.
Preoperative symptoms, especially of the lower respiratory tract, increased the risk for perioperative complications in children diagnosed with COVID-19 within 10 days of surgery.
The presence of symptoms, particularly of the lower respiratory tract, should be strongly considered in the shared decision-making process between providers and families when discussing the potential delay of procedures in the setting of COVID-19.
新型冠状病毒肺炎（COVID-19）增加了儿童麻醉风险，但对于根据症状的存在及严重程度区分并发症差异的了解有限。我们推测，有症状的COVID-19阳性儿童，尤其是有下呼吸道症状的儿童，围手术期并发症会高于无症状患者，且所有在麻醉前<6天确诊的患者并发症会更多。
这项单中心回顾性队列研究回顾了2020年3月1日至2022年3月1日接受全身麻醉手术的18岁以下COVID-19检测呈阳性儿童的记录。对总共225例在麻醉前≤10天检测呈阳性的患者进行主要结局分析，另外对298例在麻醉前≤21天检测呈阳性的患者进行次要结局分析。收集了人口统计学、合并症、疫苗接种、术前和围手术期护理、并发症及死亡率的数据。主要结局分析采用单变量回归；次要结局分析采用方差分析。
主要结局：有症状的患者术后发生呼吸并发症的可能性更高（比值比[OR]：3.53，1.18 - 10.6，p = 0.024），需要术后用药（OR：7.64，2.29 - 25.51，p = 0.001），以及需要术后氧疗支持（OR：2.62，1.19 - 5.79，p = 0.017），与无症状患者相比。与有下呼吸道症状的患者相比，有上呼吸道症状的患者术后需要用药（OR：0.1，0.01 - 0.89，p = 0.039）和氧疗支持（OR：0.08，0.01 - 0.45，p = 0.004）的可能性更低。
在麻醉前<6天检测COVID-19呈阳性的患者与其他组相比，术后在麻醉后恢复室（PACU）停留时间更长（p < 0.001），术后呼吸并发症更多（p = 0.001），用药（p = 0.038）和用氧（p = 0.002）更多。
术前症状，尤其是下呼吸道症状，增加了在手术10天内确诊COVID-19的儿童围手术期并发症的风险。
在COVID-19背景下讨论手术潜在延迟时，在医疗服务提供者与家庭之间的共同决策过程中，应充分考虑症状的存在，尤其是下呼吸道症状。
