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The association between caudal anesthesia and increased risk of postoperative surgical complications in boys undergoing hypospadias repair.

Publication ,  Journal Article
Taicher, BM; Routh, JC; Eck, JB; Ross, SS; Wiener, JS; Ross, AK
Published in: Paediatr Anaesth
July 2017

INTRODUCTION: Recent reports have suggested that caudal anesthesia may be associated with an increased risk of postoperative surgical complications. We examined our experience with caudal anesthesia in hypospadias repair to evaluate for increased risk of urethrocutaneous fistula or glanular dehiscence. METHODS: All hypospadias repairs performed by a single surgeon in 2001-2014 were reviewed. Staged or revision surgeries were excluded. Patient age, weight, hypospadias severity, surgery duration, month and year of surgery, caudal anesthesia use, and postoperative complications were recorded. Bivariate and multivariate statistical analyses were performed. RESULTS: We identified 395 single-stage primary hypospadias repairs. Mean age was 15.6 months; 326 patients had distal (83%) and 69 had proximal (17%) hypospadias. Caudal anesthetics were used in 230 (58%) cases; 165 patients (42%) underwent local penile block at the discretion of the surgeon and/or anesthesiologist. Complications of urethrocutaneous fistula or glanular deshiscence occurred in 22 patients (5.6%) and were associated with caudal anesthetic use (OR 16.5, 95% CI 2.2-123.8, P = 0.007), proximal hypospadias (OR 8.2, 95% CI 3.3-20.0, P < 0.001), increased surgical duration (OR 1.01, 95% CI 1.01-1.02, P < 0.001), and earlier year of practice (OR 3.0, 95% CI 1.2-7.9, P = 0.03 for trend). After adjusting for confounding variables via multivariable logistic regression, both caudal anesthetic use (OR 13.4, 95% CI 1.8-101.8, P = 0.01) and proximal hypospadias (OR 6.8, 95% CI 2.7-16.9, P < 0.001) remained highly associated with postoperative complications. CONCLUSIONS: In our experience, caudal anesthesia was associated with an over 13-fold increase in the odds of developing postoperative surgical complications in boys undergoing hypospadias repair even after adjusting for urethral meatus location. Until further investigation occurs, clinicians should carefully consider the use of caudal anesthesia for children undergoing hypospadias repair.

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Published In

Paediatr Anaesth

DOI

EISSN

1460-9592

Publication Date

July 2017

Volume

27

Issue

7

Start / End Page

688 / 694

Location

France

Related Subject Headings

  • Urinary Fistula
  • Surgical Wound Dehiscence
  • Risk
  • Postoperative Complications
  • Plastic Surgery Procedures
  • Perioperative Period
  • Nerve Block
  • Male
  • Infant
  • Hypospadias
 

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Taicher, B. M., Routh, J. C., Eck, J. B., Ross, S. S., Wiener, J. S., & Ross, A. K. (2017). The association between caudal anesthesia and increased risk of postoperative surgical complications in boys undergoing hypospadias repair. Paediatr Anaesth, 27(7), 688–694. https://doi.org/10.1111/pan.13119
Taicher, Brad M., Jonathan C. Routh, John B. Eck, Sherry S. Ross, John S. Wiener, and Allison K. Ross. “The association between caudal anesthesia and increased risk of postoperative surgical complications in boys undergoing hypospadias repair.Paediatr Anaesth 27, no. 7 (July 2017): 688–94. https://doi.org/10.1111/pan.13119.
Taicher BM, Routh JC, Eck JB, Ross SS, Wiener JS, Ross AK. The association between caudal anesthesia and increased risk of postoperative surgical complications in boys undergoing hypospadias repair. Paediatr Anaesth. 2017 Jul;27(7):688–94.
Taicher, Brad M., et al. “The association between caudal anesthesia and increased risk of postoperative surgical complications in boys undergoing hypospadias repair.Paediatr Anaesth, vol. 27, no. 7, July 2017, pp. 688–94. Pubmed, doi:10.1111/pan.13119.
Taicher BM, Routh JC, Eck JB, Ross SS, Wiener JS, Ross AK. The association between caudal anesthesia and increased risk of postoperative surgical complications in boys undergoing hypospadias repair. Paediatr Anaesth. 2017 Jul;27(7):688–694.
Journal cover image

Published In

Paediatr Anaesth

DOI

EISSN

1460-9592

Publication Date

July 2017

Volume

27

Issue

7

Start / End Page

688 / 694

Location

France

Related Subject Headings

  • Urinary Fistula
  • Surgical Wound Dehiscence
  • Risk
  • Postoperative Complications
  • Plastic Surgery Procedures
  • Perioperative Period
  • Nerve Block
  • Male
  • Infant
  • Hypospadias