key: cord-0953596-5b9n3oev authors: Cronin, Jessica A.; Nelson, Jonathon H.; Farquhar, Ian; Braffett, Barbara; Bebu, Ionut; Pestieau, Sophie R.; Geng‐Ramos, Giuliana; Heitmiller, Eugenie; Deutsch, Nina title: Anesthetic outcomes in pediatric patients with COVID‐19: A matched cohort study date: 2021-03-25 journal: Paediatr Anaesth DOI: 10.1111/pan.14177 sha: 722addd41a3fa35c2460051277f753f01eab965e doc_id: 953596 cord_uid: 5b9n3oev Severe acute respiratory syndrome coronavirus 2 (SARS-Co-V-2) is now widespread in most countries. As evidence regarding the clinical implications of SARS-Co-V-2 continues to evolve, such data is crucial to inform decision making in healthcare. Pediatric patients with viral infections are known to be vulnerable to perioperative complications, often respiratory in nature. 1 Although the SARS-Co-V-2 pandemic has been raging for over a year, limited information is available regarding the perioperative and anesthetic risks associated with concurrent SARS-CO-V-2 infection, particularly in children. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is now widespread in most countries. As evidence regarding the clinical implications of SARS-CoV-2 continues to evolve, such data are crucial to inform decision-making in health care. Pediatric patients with viral infections are known to be vulnerable to perioperative complications, often respiratory in nature. 1 Although the SARS-CoV-2 pandemic has been raging for over a year, limited information is available regarding the perioperative and anesthetic risks associated with concurrent SARS-CoV-2 infection, particularly in children. Several studies have demonstrated that postoperative pulmonary complications occur frequently in adult patients with perioperative SARS-CoV-2, 2,3 however, comparable data are not available for pediatric patients. The following observational study compared anesthetic outcomes in pediatric patients with and without confirmed SARS-CoV-2 infection, undergoing general anesthesia. We hypothesized that children with confirmed SARS-CoV-2 infection are at an increased risk of developing post-anesthesia complications compared to those without. Secondarily, we hypothesized that an association exists between the presence of SARS-CoV-2-related symptoms and postanesthesia complications, among children with SARS-CoV-2. We completed a single-center, retrospective, case-control study of 35 pediatric patients with confirmed SARS-CoV-2 infection who underwent anesthesia for a surgical procedure or diagnostic study and 70 non-SARS-CoV-2 control patients, matched 1:2 by age and type of procedure. SARS-CoV-2 infection was defined as detection of the SARS-CoV-2 virus on a polymerase chain reaction (PCR) test within 7 days prior to the anesthetic. All anesthetics occurred between January 3, 2020, and September 24, 2020. The primary outcomes of the study included postanesthesia complications within 30 days of the procedure or diagnostic study under anesthesia. Secondary outcomes were 30-day mortality, hospital length of stay (LOS), and intraoperative complications. This study was approved by the institutional review board. Conditional logistic regression models were used to evaluate the relationship between cases and controls and prognostic factors. The median age of the patients was 3.7 years (IQR 1-6) with 49% female. There were no significant differences in weight between cases and controls (Table 1) . Among SARS-CoV-2 cases, the mean first positive PCR test was 2.6 days (95% CI 1.3 days, 4.0 days) prior to the anesthetic. Twenty-six percent of SARS-CoV-2 cases had postanesthesia complications compared with 1% of controls (OR = 18.00, 95% CI 2.49, 788.96, p = .0007). This included a diagnosis of systemic inflammatory response syndrome, the need for prolonged invasive or noninvasive respiratory support, vasopressor requirement, clinically significant stridor, and a small pericardial effusion. Patients with SARS-CoV-2 were more likely to exhibit preoperative upper respiratory tract infection symptoms than controls. There were no deaths within 30 days of procedure. There was also no evidence for a difference in hospital LOS between the two groups and no intraoperative complications in either group. Comparing SARS-CoV-2 patients that were symptomatic (n = 13) to those that were asymptomatic (n = 22), there was no difference in the incidence of postanesthesia complications (4 cases among the symptomatic patients vs. 5 cases among the asymptomatic patients, p = .8869) or in LOS (11.3 days among the symptomatic patients vs. 10.5 days among the asymptomatic patients, p = .8733). Note: Symptoms include cough, fever, rhinorrhea, diarrhea, cervical lymphadenopathy, sore throat, or acute respiratory failure. Bold value indicates p < .05. Abbreviation: URI, upper respiratory infection. *p-Value from stratified exact logistic regression models. **p-Value = .0546 with the number of chronic conditions as a quantitative variable defined as 0 = no chronic conditions, 1 = one chronic condition, and 2 = two or more chronic conditions. Chronic conditions included: asthma, congenital heart disease, cancer, history of prematurity, diagnosed congenital syndrome with multiple comorbidities, or other. Other conditions included hepatoblastoma, seizures, sickle cell anemia, or history of necrotizing enterocolitis with dependence on total parental nutrition. The authors report no conflict of interest. Data sharing is not applicable to this article as no new data were created or analyzed in this study. Jessica A. Cronin https://orcid.org/0000-0002-2583-084X Giuliana Geng-Ramos https://orcid.org/0000-0003-0692-8371 Nina Deutsch https://orcid.org/0000-0001-7137-4737 Incidence of severe critical events in paediatric anaesthesia (APRICOT): a prospective multicentre observational study in 261 hospitals in Europe Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study Outcomes of patients with confirmed SARS-CoV-2 infection undergoing anesthesia: a pilot study American Society of Anesthesiologists and Anesthesia Patient Safety Foundation Joint Statement on Elective Surgery and Anesthesia for Patients after COVID-19 Infection