The Impact of Anesthesia Duration on Postoperative Cognitive and Behavioral Outcomes in Pediatric Patients: A Meta-analysis.

PURPOSE: To systematically assess and quantify the relationship between length of anesthesia time and postoperative cognitive and behavioral changes in children, by combining data from published studies to evaluate possible duration-based effects and to use them to support future clinical recommendations.

DESIGN

The study is a systematic review and meta-analysis conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

METHODS

The search strategy included a systematic search of Google Scholar, PubMed, Scopus, and Web of Science for publications over the past 15 years. Inclusion criteria included randomized clinical trials and observational studies that included pediatric subjects (0 to 18 years) who underwent surgery under general anesthesia with cognitive or behavioral outcomes reported postoperatively. Studies were placed into groups based on short (<1 hour), moderate (1 to 3 hours), and prolonged anesthesia duration (>3 hours). A random-effects model was utilized for meta-analyses and effect sizes were calculated, heterogeneity was reported using the I² statistic.

FINDINGS: The systematic review and meta-analysis included 15 studies that met inclusion and exclusion criteria. No overall effect of duration of anesthesia was found on verbal, performance, or full-scale intelligence quotient (IQ); however, a significant reduction in verbal IQ was observed in the 1- to 2-hour group (mean difference = -2.00, 95% confidence intervals [CI] = -2.53 to -1.47, P < .00001). Behavior problems were measured by the Child Behavior Checklist total problems score, which showed the strongest increases in failures for the durations of less than 2 hours, while greater durations noted strong associations with attention-deficit hyperactivity disorder (ADHD) (hazard ratio = 1.99, 95% CI: 1.40 to 2.83, P = .0001) and learning disabilities (hazard ratio = 1.71, 95% CI: 1.38 to 2.12, P < .00001). Heterogeneity appeared relatively small across these outcomes, and variability of behaviors was much lower for ADHD and learning disabilities compared with IQ measures and Child Behavior Checklist total problems.

CONCLUSIONS

Anesthesia duration has a significant effect on certain cognitive and behavioral outcomes in children. We found that anesthesia exposures of 1 to 2 hours were associated with decreased verbal IQ, and longer durations were associated with ADHD and learning disability. These results demonstrate the importance of planning for anesthesia exposure and standardized approaches in future anesthetic and cognitive studies.