Despite effective new treatments for their disease, children with pulmonary hypertension (PHT) are still a high-risk group for serious complications and death related to anaesthesia and surgery, according to a study published in the February issue of the journal Anesthesia & Analgesia.
“The risk for adverse events during anaesthesia in patients with PHT remains high, despite newer disease-modifying treatments,” wrote Katherine Taylor, MD, Hospital for Sick Children, Toronto, Ontario, and colleagues.
Younger children and those with more severe disease are at higher risk, but larger studies will be needed to understand the risks of anaesthesia in the era of modern treatments for PHT.
For the study, the researchers analysed adverse events in 122 infants and children (median age, 2.2 years) with PHT undergoing surgery with general anaesthesia between 2008 and 2012. The patients underwent a total of 264 non-heart surgeries. In most patients, PHT was related to congenital heart defects. Forty-three percent of operations were performed while the children were receiving newer disease-modifying treatments.
Minor complications occurred in about 4% of procedures and major complications in a little over 3%. Three children died, for a risk of about 1% per surgery. These adverse outcome rates were in the range reported by previous studies, before the new PHT treatments were introduced.
Complication rates were somewhat lower for children receiving the new disease-modifying drugs: 4.1% versus 8.6% for overall complications, and 2.5% versus 3.7% for serious complications. However, after adjustment for the severity of PHT, the new treatments had no significant effect on complication risk.
On further analysis, rates of complications and death remained significantly higher for children with more severe PHT — including those receiving home oxygen therapy and those undergoing lengthier surgical procedures. Age was also a strong risk factor, with younger children being at higher risk. The risk of serious complications was 6 times higher for infants younger than 5 months, compared with those aged 2 years or older.
“The risk for adverse events during anaesthesia in patients with PHT remains high, despite newer disease-modifying treatments,” the authors wrote.
They noted that their study is the largest to date of infants and children with PHT, and the only one performed since the effective new PHT treatments were introduced.
Yet the single-hospital study still doesn’t include enough events to evaluate the various contributors to adverse events. Collaborative studies including data from multiple hospitals will be needed to address unanswered questions about the risks of surgery and anaesthesia in children with PHT, including the role of disease-modifying treatments.
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