Delayed Surgery Does Not Lower Child Anesthesia Risk

Children under age five who undergo general anesthesia (GA) for minor surgery have an increased risk of attention deficit hyperactivity disorder (ADHD) and other mental diagnoses, according to a new study.

Researchers at the Columbia University College of Physicians and Surgeons (New York, NY, USA) conducted an observational cohort study to determine if the timing of exposure to GA under the age of five was associated with an increased subsequent risk of diagnoses for mental disorders, such as developmental delays, ADHD, depression, or anxiety. To do so, they analyzed data on four common childhood procedures that require GA, including circumcision beyond the perinatal period, hernia repair, adenoidectomy, and tonsillectomy.


A total of 38,493 children who underwent one of the four surgical procedures, and 192,465 children unexposed to GA before five years of age were included in the analysis. Exposure to GA and surgery was evaluated in 11 separate age categories over the five years. For each child exposed to GA, five matched children were selected for comparison. The results revealed that the children who received any one of the four common procedures had a 26% increased risk of a diagnosis for a mental disorder, which did not vary with the timing of the procedure.

The most common mental disorders were developmental delay and ADHD, and exposure to GA for one of these procedures was associated with a 26% increased risk of diagnosis of a developmental delay, and 31% increased risk for a diagnosis of ADHD. Based on the results, the researchers conclude that there is little support for delaying a minor surgical procedure so as to reduce long-term neurodevelopmental risks of GA in children. The study was published on September 14, 2017, in Anesthesia & Analgesia.

“The question of whether commonly used anesthetics have any measurable adverse effect on neurodevelopment in children has been a hot topic in anesthesia and surgery for over a decade,” said senior author professor of epidemiology Guohua Li, MD, PhD. “This rigorously designed study may help parents and clinicians to make informed decisions on elective surgeries for kids.”

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