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ACUTE CHEST SYNDROME POST SURGERY IN CHILDREN WITH SICKLE CELL DISEASE

Departments of Anesthesia and Surgery, The Hospital for Sick Children, Toronto,Ontario, M5G 1X8

INTRODUCTION:

Acute chest syndrome (ACS) is the main cause of death among patients with sickle cell disease (SCD) (1). ACS can occur as a post-surgical complication and is associated with increased postoperative pain, prolonged hospital stay, permanent deterioration in pulmonary function, and increased mortality (2,3). We determined the incidence of ACS at our institution and assessed any factors that might predispose to this complication. Additionally, we assessed whether the use of laparoscopic surgery had decreased the incidence of ACS in children having intracavitary abdominel procedures.

METHODS:

With REB approval, we reviewed the charts of all children with SCD undergoing surgery or invasive procedures requiring general anesthesia from 1989-1999. Data regarding patient demographics, preoperative physiological variables, intraoperative course and outcome were collected. ACS was defined as the development of symptoms and signs of respiratory distress in association with a new pulmonary infiltrate confirmed by radiological investigation. Unpaired T-tests or Fisher exact test were used to determine statistical significance (P<0.05).

RESULTS:

Of 118 procedures reviewed, 61 were for cholecystectomy or splenectomy. ACS occurred postoperatively in 11 of these 61 children (18%). There were no instances of ACS in children having non-abdominal surgery and no deaths. The incidence of ACS in children who had an open surgical approach for cholecystectomy or splenectomy was similar to that in the group that had a laparoscopic approach. Postoperative stay was significantly prolonged when ACS occurred (9±2 vs. 4±2 days, P<0.0001). Radiological infiltrates were present unilaterally on the side of surgery in eight of the 11 cases and bilaterally in three cases. Apart from intracavitary abdominal surgery, we were unable to identify any specific predisposing factor for the development of ACS.

DISCUSSION:

Intracavitary abdominal surgery is associated with a high postoperative risk of ACS in the child with sickle cell disease. Laperoacopic surgery did not decrease the incidence of ACS. The prolonged hospital stay after ACS has considerable fiscal implications. Radiological evidence of chest infiltrates occurred predominantly on the side of surgery, which might implicate basal atelactesis in the etiology of ACS.

REFERENCES:

1 NEJM 342; 1855.

2 Blood 86; 3676.

3 Arch Dis Child 66; 330.

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