K. Williams1, B. Nwomeh2, T. A. Oyetunji3 1Howard University College Of Medicine,General Surgery,Washington, DC, USA 2Nationwide Children’s Hospital,Columbus, OH, USA 3Children’s Mercy Hospital- University Of Missouri Kansas City,Kansas City, MO, USA
Introduction: Increasing attention is being paid to the neurotoxicity and potential long-term cognitive effects of general anesthesia (GA) in children younger than 3 years old. This study aims to describe the most common pediatric surgical procedures requiring GA in children less than 3 years, and the potential discordance in nonoperative anesthesia time and operative anesthesia time.
Methods: The National Surgical Quality Improvement Program Pediatric (NSQIP-P) database for 2012-2013 was queried for all children 3 years old or less who underwent GA for an inpatient pediatric general surgical procedure. Demographic data, procedure by Current Procedural Terminology (CPT) code, case type, operating time, anesthesia time, and American Society of Anesthesiologists (ASA) class were descriptively analyzed. Those who underwent additional procedures during the same anesthesia period were excluded. For each procedure, the difference between total anesthesia time and total operating time was calculated, yielding the nonoperative anesthesia time.
Results: A total of 5143 patients were identified. Of these, 63% were male and 68% were White. The median age at admission was 64 days (IQR 28-294) and 78% were infants. Most cases were elective (59%), and the most common ASA class was 2 (38%). The most common procedures performed in children younger than 3 years were pyloromyotomy (21%), laparoscopic gastrostomy (8.6%), and unlisted procedures on the stomach (6.6%). The median nonoperative anesthesia times were 45 mins (IQR 37,55), 48 mins (IQR 37, 64), and 48 mins (IQR 38, 62) respectively. (Table 1)
Conclusion: For the most common procedures requiring GA in children less than 3 years, the median nonoperative anesthesia time exceeds operative anesthesia time by more than 45 minutes, suggesting that this is a potentially modifiable target for decreasing anesthetic exposure. The provider and systems level factors that contribute to this time discordance need to be explored.
