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

• DOI: 10.1111/pan.13119
• Publication Date: 2017-03-27T10:17:09Z
• Authors: Brad M. Taicher; Jonathan C. Routh; John B. Eck; Sherry S. Ross; John S. Wiener; Allison K. Ross
• Keywords: Male; Risk; Hypospadias; Urinary Fistula; Infant; Nerve Block; Plastic Surgery Procedures; 3. Good health; Cohort Studies; 03 medical and health sciences; Postoperative Complications; 0302 clinical medicine; Surgical Wound Dehiscence; Humans; Perioperative Period; Anesthesia, Caudal

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