• Anitra Karthic, Zandantsetseg Orgil, Sidhant Kalsotra, Michelle Cugino, Adelei Durban, Nguyen K Tram, Julie Rice-Weimer, Brittany L Willer, Ajay D'Mello, Joseph D Tobias, and Vanessa A Olbrecht.
• Department of Anesthesiology, Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.
• Paediatr Anaesth. 2024 Dec 5.

IntroductionCOVID-19 increases anesthetic risk in children, but understanding of complication differences by symptom presence and severity is limited. We hypothesized that symptomatic COVID-19+ children, especially with lower respiratory symptoms, would have higher perioperative complications than asymptomatic patients and that complications would be higher in all patients diagnosed < 6 days before anesthesia.MethodsThis single-center, retrospective cohort study reviewed records of children < 18 years old undergoing surgery with general anesthesia from March 1, 2020, to March 1, 2022, who tested COVID-19+. A total of 225 patients who tested positive ≤ 10 days before anesthesia were analyzed for the primary outcome, and an additional 298 patients who tested positive ≤ 21 days before anesthesia were analyzed for secondary outcomes. Data on demographics, comorbidities, vaccination, preoperative and perioperative care, complications, and mortality were collected. Primary outcome analysis used univariate regression; secondary outcome analysis used analysis of variance.ResultsPrimary Outcome: Symptomatic patients were more likely to experience postoperative respiratory complications (OR: 3.53, 1.18-10.6, p = 0.024), require postoperative medications (OR: 7.64, 2.29-25.51, p = 0.001), and require postoperative oxygen support (OR: 2.62, 1.19-5.79, p = 0.017) versus asymptomatic patients. Those with upper respiratory symptoms were less likely to require postoperative medications (OR: 0.1, 0.01-0.89, p = 0.039) and oxygen support (OR: 0.08, 0.01-0.45, p = 0.004) versus those with lower respiratory symptoms.Secondary OutcomePatients testing COVID-19+ < 6 days before anesthesia had longer PACU stays (p < 0.001) and more postoperative respiratory complications (p = 0.001), medication use (p = 0.038), and oxygen use (p = 0.002) versus other groups.DiscussionPreoperative symptoms, especially of the lower respiratory tract, increased the risk for perioperative complications in children diagnosed with COVID-19 within 10 days of surgery.ConclusionThe presence of symptoms, particularly of the lower respiratory tract, should be strongly considered in the shared decision-making process between providers and families when discussing the potential delay of procedures in the setting of COVID-19.© 2024 The Author(s). Pediatric Anesthesia published by John Wiley & Sons Ltd.

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