Epidemiology of general anesthesia prior to age 3 in a
population-based birth cohort
Erin L. Rodgers
Slavica K. Katusic
Stephen J. Gleich
Andrew C. Hanson
Darrell R. Schroeder
Randall P. Flick
David O. Warner
Department of Anesthesiology and
Perioperative Medicine, Mayo Clinic,
Rochester, MN, USA
Department of Health Sciences Research,
Mayo Clinic, Rochester, MN, USA
Dr David O. Warner, Department of
Anesthesiology and Perioperative Medicine,
Mayo Clinic, Rochester, MN, USA.
This work was supported by from the
Eunice Kennedy Shriver National Institute of
Child Health and Human Development of
the National Institutes of Health, and also
utilized the resources of the Rochester
Epidemiology Project, supported by R01
AG034676 from the National Institute on
Aging of the National Institutes of Health.
Section Editor: Joseph Cravero
Background: Utilization of general anesthesia in children has important policy, eco-
nomic, and healthcare delivery implications, yet there is little information regarding
the epidemiology of these procedures in the United States.
Aims: The primary objective of this study was to describe in a geographically
defined population the incidence of procedures requiring general anesthesia up to
the child’s third birthday, and the patient characteristics associated with receiving
these procedures. A secondary objective was to determine the proportion of chil-
dren in the population who meet the risk criteria promulgated by the Food and
Drug Administration (FDA).
Methods: A retrospective cohort of children born from 1994 to 2007 in Olmsted
County, MN was established. Birth certificate information and receipt of general
anesthesia before age 3 were collected. Proportional hazard regressions were per-
formed to evaluate the association between characteristics of children and incidence
of general anesthesia.
Results: Among the 20 922 children in the cohort, 3120 (14.9%) underwent at least
1 general anesthesia before age 3. In multivariate regression, factors independently
associated with receiving at least 1 procedure included prematurity, male sex, lower
birth weight, cesarean delivery, a non-Hispanic mother, and a White mother, con-
trolling for multiple gestation, number of children previously born, age, education,
and marital status of the mother. Seven hundred and twenty-three children (3.5%)
had at least 1 subsequent procedure. Estimated gestational age <32 weeks and low
birth weight were independently associated with receiving repeated anesthesia.
Eight hundred and twenty children (3.9%) had a single prolonged exposure above
3 hours, multiple exposures prior to age 3, or both.
Conclusion: Approximately 1 in 7 children were exposed to at least 1 episode of
general anesthesia before age 3, and approximately 1 in 4 children who received
general anesthesia fall within the high-risk category as defined by the recent FDA
warning. The apparent disparities in surgical utilization related to race and ethnicity
in this study population deserve further exploration.
anesthesia, child, ethnic groups, general, gestational age, incidence, infant, low birth weight
Accepted: 15 February 2018
Pediatric Anesthesia. 2018;28:513–519. wileyonlinelibrary.com/journal/pan © 2018 John Wiley & Sons Ltd