Incidence of and risk factors for perioperative or periprocedural anaphylaxis in the United States from 2005 to 2014 |
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| Authors: | Alexei Gonzalez-Estrada Ismael Carrillo-Martin J. Ross Renew Matthew A. Rank Ronna L. Campbell Gerald W. Volcheck |
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| Affiliation: | 1. Division of Pulmonary, Allergy and Sleep Medicine, Department of Medicine, Mayo Clinic, Jacksonville, Florida;2. Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, Florida;3. Division of Allergy, Asthma and Clinical Immunology, Department of Medicine, Mayo Clinic, Scottsdale, Arizona;4. Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota;1. Department of Allergy and Clinical Immunology, Cleveland Clinic Foundation, Cleveland, Ohio;2. Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio;1. Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass;2. Department of Medicine, Harvard Medical School, Boston, Mass;3. Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass;4. Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Mass;5. Division of Allergy and Inflammation, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass;6. Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, Calif;7. Department of Anesthesia, Massachusetts General Hospital, Boston, Mass;1. Department of Clinical Immunology, Oxford, UK;2. Department of Anaesthesia, Oxford University Hospitals NHS Foundation Trust, Oxford, UK;1. Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA, 71103, USA;2. School of Medicine, LSU Health Sciences Center New Orleans, 2020 Gravier Street, New Orleans, LA, 70112, USA;3. LSUHSC, New Orleans, USA;4. LSU Health Sciences Center New Orleans, 433 Bolivar Street, New Orleans, LA, 70112, USA;5. Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA;6. Division of Family Medicine, HCA Houston Healthcare West, 12141 Richmond Ave. Houston, TX, 77082, USA;7. Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women''s Hospital, 75 Francis St, Boston, MA, 02115, USA;8. Departments of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA |
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| Abstract: | ![]()
BackgroundThe estimated worldwide incidence of perioperative or periprocedural anaphylaxis (PA) is between 1 in 1250 and 1 in 20,000 procedures.ObjectiveTo evaluate the incidence of PA in the United States and compare patient characteristics and underlying risk factors using a large national database.MethodsUsing deidentified data from the nationwide inpatient sample from 2005 to 2014, we identified cases of PA through the International Classification of Diseases, Ninth Revision, Clinical Modification codes and conducted a retrospective analysis.ResultsAmong 35,647,347 surgeries and procedures, there were 5458 (0.015%) PA cases identified. The incidence of PA was 15.3 cases per 100,000 procedures. When compared with controls, PA cases had an increased mortality (3.4% vs 1.4%; P < .001), median length of stay (5 vs 3 days; P < .001), and median hospital cost ($45,155 vs $24,734; P < .001). The age group between 18 and 34 years (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.13-1.58; P < .001) and female sex (OR, 1.40; 95% CI, 1.31-1.49; P < .001) were associated with increased odds of PA. Transplant (OR, 3.35; 95% CI, 2.59-4.34; P < .001), hematologic (OR, 1.63; 95% CI, 1.30-2.05; P < .001), vascular (OR, 1.49; 95% CI, 1.30-1.67; P < .001), and cardiac (OR, 1.47; 95% CI, 1.30-1.67; P < .001) procedures were at increased risk for PA. Several comorbidities were associated with PA including chronic pulmonary disease (OR, 1.41; 95% CI, 1.31-1.51; P < .001).ConclusionThe incidence of PA is 1 in 6531 procedures, with a mortality of 1 in 191,652 procedures. PA has worsening outcomes compared with controls. The risk factors of PA include age, sex, procedure type, and comorbidities. |
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