Risk factors for acute chest syndrome in children with sickle cell disease undergoing abdominal surgery

Abstract

Background/purpose The reported incidence of acute chest syndrome (ACS) in children with sickle cell disease (SCD) is 15% to 20%. Our current objective was to assess risk factors and morbidity associated with ACS. Methods The authors reviewed the outcome of children with SCD undergoing abdominal surgery over a 10-year period. Results From 1991 to 2003, 60 children underwent laparoscopic cholecystectomy (LC; n = 29), laparoscopic splenectomy (LS; n = 28), or both (LB; n = 3). Mean age was 8.6 (0.7 to 20) years, and 35 (58%) were boys. Fifty-four (90%) had a preoperative hemoglobin greater than 10 g/dL, but only 22 (37%) received routine oxygen after surgery. No surgery was converted to an open procedure. Four children (6.6%), all of whom underwent either LS or LB, had ACS associated with an increased length of stay (7.4 ± 2.4 days) but no mortality. Factors associated with the development of ACS were age (3.0 ± 1.7 v 9.4 ± 5.7 years; P = .03), weight (12.1 ± 3.0 v 32.6 ± 18.2 kg; P = .04), operative blood loss (3.2 ± 0.5 v 1.4 ± 1.2 mL/kg; P = .03), and final temperature in the operating room (OR; 36.2 ± 0.4 v 37.6 ± 0.4 °C; P = .01). ACS was not significantly related to duration of surgery, OR fluids, or oxygen usage. Conclusions Younger children with greater blood and heat loss during surgery appear more prone to ACS. Splenectomy also seems to increase the risk of ACS. The authors’ current incidence (6.6%) of ACS in children with SCD undergoing abdominal surgery is much lower than previously reported. This may be explained by the aggressive use of preoperative blood transfusion or more routine use of laparoscopy.