YIG-382
Surgery in early life and child development at school-entry: A sibling cohort
1O'Leary J, 2Janus M, 2Duku E, 3Wijeysundera D, 4To T, 4Li P, 1Faraoni D, 1Crawford M
1The Hospital for Sick Children, Toronto, Ontario, Canada; 2McMaster University, Hamilton, Ontario, Canada; 3University of Toronto, Toronto, Ontario, Canada; 4nstitute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
Introduction: There is substantial preclinical evidence that the developing brain is susceptible to injury from anesthesia or painful interventions in early life. Although clinical studies have had mixed findings, two large Canadian provincial studies have both indicated that exposure to childhood surgery is associated with worsened child development outcomes (1,2). However, exposure to anesthesia and surgery has been found to explain only a small fraction of the variability in child development outcomes, and much less than other risk factors such as home environment and socio-economic covariates. The aim of this study was to determine risks of adverse child development after anesthesia and surgery in early life among siblings, thus mitigating effects of demographic and environmental influences on child development.
Methods: With research ethics board approval, provincial health administrative and demographic databases in Ontario, Canada, were linked to children’s developmental outcomes measured by the Early Development Instrument (EDI). The EDI is a validated 103-item teacher-completed questionnaire used to assess children’s readiness to learn in five major domains (physical health and well-being, social knowledge and competence, emotional health and maturity, language and cognitive development, and communication skills and general knowledge). Siblings were first identified, and were then classified according to exposure to surgery prior to EDI completion (age 5 to 6 years). From 216,669 eligible children who completed the EDI, 2,346 discordant (exposure vs. no exposure) sibling-pairs were identified. The primary outcome was early developmental vulnerability, defined as any domain of the EDI in the lowest tenth percentile of the population. Secondary outcomes included performance in major EDI domains.
Results: There was no effect of age at exposure (P=0.2), number of exposures (P=0.6), and physiological complexity of procedures (P=0.6) on early developmental vulnerability among children who underwent surgery. After adjusting for potential confounding factors (age at EDI completion, sex, mother’s age at birth, eldest sibling status), there were no significant differences between exposed and unexposed siblings in early developmental vulnerability, overall (adjusted odds ratio 1.14, 95% confidence interval 0.98 to 1.32; P = 0.10) and for all of the major EDI domains (each, P>0.3). Similarly, there was no effect of surgery in early life on any of the major EDI domain scores after adjusting for confounding factors.
Discussion: After mitigating for potential demographic and environmental influences on child development, this sibling cohort study found that there were no differences between children exposed and unexposed to surgery in early life in any of the child development domains measured using the EDI. These findings are consistent with recent clinical studies using direct neurodevelopmental testing.
Conclusions: Children who undergo surgery prior to school-entry were not found to be at increased risk of adverse child development compared to their siblings who do not undergo surgery.
References
1. O’Leary et al. Anesthesiology 2016; 125: 272-279
2. Graham et al. Anesthesiology 2016; 125: 667–77
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