Epidemiology of general anesthesia prior to age 3 in a population-based birth cohort.
Epidemiology of general anesthesia prior to age 3 in a population-based birth cohort.
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DOI：
10.1111/pan.13359
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发表时间：
2018-06
期刊：
影响因子：
--
通讯作者：
Warner DO
中科院分区：
文献类型：
--
作者：
Shi Y;Hu D;Rodgers EL;Katusic SK;Gleich SJ;Hanson AC;Schroeder DR;Flick RP;Warner DO
在儿童中使用全身麻醉具有重要的政策、经济和医疗保健提供影响，但有关美国这些手术的流行病学的信息很少。本研究的主要目的是描述在地理上确定的人群中，直到孩子三岁生日之前需要全身麻醉的手术的发生率，以及与接受这些手术相关的患者特征。第二个目标是确定人口中符合美国食品和药物管理局 (FDA) 颁布的风险标准的儿童比例。对 1994 年至 2007 年出生于明尼苏达州奥姆斯特德县的儿童进行了回顾性队列研究。收集出生证明信息和 3 岁之前的全身麻醉收据。进行比例风险回归来评估儿童特征与全身麻醉发生率之间的关联。在队列中的 20922 名儿童中，3120 名（14.9%）在 3 岁之前接受过至少 1 次全身麻醉。在多变量回归中，与接受至少 1 次手术独立相关的因素包括早产、男性、出生体重较低、剖腹产、非西班牙裔母亲和白人母亲，并控制了多胎妊娠、先前出生的孩子数量、母亲的年龄、教育程度和婚姻状况。 723 名儿童 (3.5%) 至少接受过 1 次后续手术。估计胎龄<32周和低出生体重与接受重复麻醉独立相关。 820 名儿童 (3.9%) 曾单次长时间暴露于 3 小时以上、3 岁之前多次暴露，或两者兼而有之。大约七分之一的儿童在 3 岁之前接受过至少 1 次全身麻醉，大约四分之一接受全身麻醉的儿童属于 FDA 最近警告所定义的高风险类别。在本研究人群中，与种族和民族相关的手术利用率的明显差异值得进一步探讨。
Utilization of general anesthesia in children has important policy, economic, and healthcare delivery implications, yet there is little information regarding the epidemiology of these procedures in the United States. The primary objective of this study was to describe in a geographically defined population the incidence of procedures requiring general anesthesia up to the child’s third birthday, and the patient characteristics associated with receiving these procedures. A secondary objective was to determine the proportion of children in the population who meet the risk criteria promulgated by the Food and Drug Administration (FDA). A retrospective cohort of children born from 1994 to 2007 in Olmsted County, MN was established. Birth certificate information and receipt of general anesthesia before age 3 were collected. Proportional hazard regressions were performed to evaluate the association between characteristics of children and incidence of general anesthesia. Among the 20 922 children in the cohort, 3120 (14.9%) underwent at least 1 general anesthesia before age 3. In multivariate regression, factors independently associated with receiving at least 1 procedure included prematurity, male sex, lower birth weight, cesarean delivery, a non-Hispanic mother, and a White mother, controlling for multiple gestation, number of children previously born, age, education, and marital status of the mother. Seven hundred and twenty-three children (3.5%) had at least 1 subsequent procedure. Estimated gestational age <32 weeks and low birth weight were independently associated with receiving repeated anesthesia. Eight hundred and twenty children (3.9%) had a single prolonged exposure above 3 hours, multiple exposures prior to age 3, or both. Approximately 1 in 7 children were exposed to at least 1 episode of general anesthesia before age 3, and approximately 1 in 4 children who received general anesthesia fall within the high-risk category as defined by the recent FDA warning. The apparent disparities in surgical utilization related to race and ethnicity in this study population deserve further exploration.
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影响因子：
8
作者：
Flores, Glenn;Tomany-Korman, Sandra C.
通讯作者：
Tomany-Korman, Sandra C.
影响因子：
8.9
作者：
St Sauver, Jennifer L.;Grossardt, Brandon R.;Rocca, Walter A.
通讯作者：
Rocca, Walter A.
影响因子：
3.7
作者：
Hu, Danqing;Flick, Randall P.;Warner, David O.
通讯作者：
Warner, David O.
影响因子：
6.3
作者：
Katusic, Slavica K.;Colligan, Robert C.;Weaver, Amy L.
通讯作者：
Weaver, Amy L.
影响因子：
2.2
作者：
Gleich, Stephen J.;Flick, Randall;Warner, David O.
通讯作者：
Warner, David O.