Patterns of Anesthesia Use in a Large Multi-Institution Pediatric Cohort: A Report of the Pediatric Proton/Photon Consortium Registry (PPCR) Study

Abstract

Daily anesthesia is commonly used for pediatric patients undergoing radiation therapy. However, general anesthesia increases the short- and long-term risks of treatment, is emotionally difficult for patients and families, and requires greater personnel and facility resources. Strategies for mitigating use of anesthesia is of increasing interest. Prior reports of anesthesia use rates are from single institutions, the largest involving 779 patients. In this study, we used a large multi-institution cohort to characterize anesthesia use in pediatric patients undergoing proton therapy.We reviewed prospectively-collected data on pediatric patients treated with proton therapy for whom anesthesia data is available in the Pediatric Proton/Photon Consortium Registry (PPCR). We calculated frequency of anesthesia use by age, grouping patients ≤3 years old, ≥11 years old, and by single years in age between. We then assessed the 6-7-year-old population for characteristics associated with increased risk of anesthesia use. These patients are on the threshold of being able to undergo treatment without anesthesia, and therefore the use of anesthesia reflects more nuanced decisions. We evaluated for association between anesthesia use and gender, primary disease site (CNS vs non-CNS), craniospinal irradiation (CSI), treatment era, race/ethnicity, and English vs non-English speaking.A total of 3103 pediatric patients (age range 0 - 21 years old) treated at 17 proton therapy centers in the United States from 2001 - 2021 were included in the current study. Receipt of any anesthesia for a radiation therapy course decreased with age, ranging from 96.6% in ages 0-3 years old to 3.4% in ages ≥11 years old. Within the 6-7-year-old population, 53.1% of patients with a CNS primary received anesthesia vs 37.6% of patients with a non-CNS primary site, (P = 0.01). The difference was more pronounced for CSI, with 74.1% of CSI patients receiving anesthesia vs. 35.9% of non-CSI patients receiving anesthesia, (P < 0.001). Rates of anesthesia use were nearly identical in patients treated before 2016 vs. 2016 and after, (36.9% vs 37.7% for whole cohort, 49.0% vs 48.4% in 6-7 years old). Thirty-five and a half percent of African-American patients received anesthesia, compared with 43.3% of Hispanic patients and 51.3% in all other racial/ethnic groups. However, this difference did not hold when controlling for CNS disease or treatment with CSI.In this cohort of over 3000 patients, age and receipt of CSI were the most important predictors of anesthesia use with proton therapy. There is no significant difference among different race/ethnicity, or non-English speaking patients when controlling for receipt of CSI.