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. “The risk for adverse events during anesthesia in patients with PHT remains high, despite newer disease-modifying treatments,” Science Daily reports the study by Dr Katherine Taylor and colleagues of the Hospital for Sick Children, Toronto found. Younger children and those with more severe disease are at higher risk, but larger studies will be needed to understand the risks of anesthesia in the era of modern treatments for PHT, researchers said.
They analysed adverse events in 122 infants and children with PHT undergoing surgery with general anaesthesia between 2008 and 2012. Historically, children with PHT have had not only a shortened life expectancy, but also a high risk of serious anaesthesia-related complications. As a result, surgery was avoided except in extreme cases.
But in the past five years, new “disease-modifying” treatments have substantially improved survival for infants and children with PHT. “Consequently, patients are now presenting to anaesthesia/surgical services for procedures associated with PHT and other childhood and adolescence illnesses,” Taylor and coauthors write. They evaluated patterns of complications occurring under current approaches to managing PHT.
The 122 patients, median age 2.2 years, underwent a total of 264 non-heart surgeries. In most patients, PHT was related to congenital heart defects and 43% of operations were performed while the children were receiving the 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 six times higher for infants younger than five months, compared to those aged two years or older.
The report says the single-hospital study still doesn’t include enough events – a total of nine serious complications and three deaths – 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.