Impact of high spinal anesthesia in pediatric congenital heart surgery on postoperative recovery: a retrospective propensity score-matched study

Background: High spinal anesthesia (HSA) has been utilized in cardiac surgery; however, there is limited evidence on its impact on facilitating postoperative recovery. This study aimed to evaluate the impact of HSA in pediatric congenital heart surgery on postoperative recovery. Methods: A single center, propensity score-matched retrospective cohort study was designed using data from pediatric patients under 18 years old, who underwent congenital heart surgeries classified as Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1) score 3 or less. The comparison was made between the HSA group, who received HSA in addition to general anesthesia (GA), and the GA group, who received GA alone. The primary outcome was the odds of patients being extubated in the operating room. Secondary outcomes included the odds of patients being extubated within 6 hours after intensive care unit (ICU) admission, as well as the length of stay (LOS) in the ICU and the hospital. Results: A total of 566 cases were eligible for this study, with 224 cases in the HSA group and 342 cases in the GA group. Propensity score-matching yielded a total of 197 pairs of patients. The rates of extubation in the operating room and within 6 hours after ICU admission were significantly higher in the HSA group compared to the GA group [65.5% vs. 33.5%, odds ratio 3.82, 95% confidence interval (CI): 2.5 to 5.8, P<0.001; 82.7% vs. 61.9%, odds ratio 2.95, 95% CI: 1.9 to 4.7, P<0.001, respectively]. The LOS in the ICU was significantly shorter in the HSA group while there was no significant difference in the LOS in the hospital between groups (5.1 vs. 8.0 days, P<0.001; 8.7 vs. 9.5 days, P<0.60, respectively). Conclusions: The addition of HSA to GA in fast-track pediatric congenital heart surgery was associated with increased odds of extubation in the operating room, within 6 hours of ICU admission, and with a shorter LOS in the ICU. Future randomized controlled trials are needed to confirm these results.