Abstract

RRA-5

Race and perioperative critical airway complications in children undergoing Ear, Nose and Throat procedures

Foley A, Nafiu O
University of Michigan, Ann Arbor, MI, USA

Background: Perioperative critical airway obstruction (CAO) including laryngospasm or bronchospasm is a potentially devastating complication of pediatric anesthesia (1). This leads to rapid escalation of care in the perioperative period. Risk factors for these serious complications are poorly elucidated, however race is a well-known association (2). Many of the common risk factors for CAO and perioperative respiratory adverse events (PRAE) appear to disproportionately affect minority children. Black children have higher rates of bronchial asthma (BA), sleep disordered breathing (SDB) and obesity compared to their white peers (3). Furthermore, black children often have poorly controlled disease symptomatology which puts them at higher risk for CAO (4). Despite this, the association of race with perioperative CAO has not been comprehensively examined (5). The purpose of this study was to determine the frequency of perioperative CAO and to test its association with self-reported racial category in children.
Methods: We examined the association between race and perioperative CAO among black and white children (N=7242) who underwent various ENT procedures. We conducted race-based analyses with and without preoperative respiratory comorbidities (asthma and sleep disordered breathing). Multivariable logistic regression analysis was used to calculate adjusted odds for CAO using age, gender, body mass index (BMI), SDB, BA, recent URI and use of ETT as covariates.
Results: Among the 7242 subjects, 13.0% were black. Perioperative CAO occurred in 5.6%, laryngospasm in 4.2% and bronchospasm in 1.2% of patients. Black patients had increased odds ratio (OR) of laryngospasm (OR 1.75; 95% CI = 1.33-2.29); bronchospasm (OR 3.92; 95% CI = 2.72-5.65); and CAO (OR 2.09; 95% CI = 1.68-2.61) – Fig1a. These associations with black race remained significant for bronchospasm (OR 4.40; 95% CI = 1.92-10.13) and CAO (OR 1.72; 95% CI = 1.04-2.83) but not for laryngospasm (OR 1.29; 95% CI = 0.69-2.39) when children with pre-existing history of BA and SDB were excluded (Fig.1b). On multivariable analysis, black patients were independently associated with increased odds of perioperative CAO (OR =1.63; 95% CI, 1.05-2.62; p=0.03).
Conclusion: Black children were significantly more likely to suffer perioperative CAO than their white peers even among those without preoperative respiratory disorders. Mechanisms underlying this racial susceptibility to serious perioperative complications deserve further elucidation.
References: (1). Paediatr Anaesth. 2004;14(3):218-24. (2). Lancet 2010;376:773–783. (3) Int J Epidemiol. 2007;36:1093-102. (4). Am J Respir Crit Care Med 2004;963–68. (5). JAMA Otolaryngol Head Neck Surg.139(2):147-52.