Spinal Anesthesia and Postoperative Complications Following Pediatric Hypospadias Repair: A Retrospective Review

Grant Heydinger,1,2 Josiane Kerbage,1 Catherine Roth,1 Sibelle Aurelie Yeleme Kitio,1 Giorgio Veneziano,1,2 Joseph D Tobias,1,2 V Rama Jayanthi3 1Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, OH, USA; 2Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA; 3Department of Urology, Nationwide Children’s Hospital, Columbus, OH, USACorrespondence: Grant Heydinger, Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH, 43205, USA, Email [email protected]: Recently, concerns have been raised regarding the impact of anesthetic choice on outcomes for patients undergoing hypospadias repair. It has been suggested that caudal epidural anesthesia (CEA) may be associated with increased postoperative complications, such as urethrocutaneous fistula and glanular dehiscence. However, subsequent studies have found no association between CEA and increased complications. Spinal anesthesia (SA) is another technique that can provide surgical blockade during hypospadias repair. However, no studies have examined outcomes for pediatric patients undergoing hypospadias repair under awake SA.Methods: We performed a single-center retrospective review on all patients who underwent single-stage primary hypospadias repair from 2016 until 2023. Data collected included patient demographics, anesthetic details, severity of hypospadias, duration of procedure, and postoperative complications.Results: 805 patients underwent single-stage hypospadias repair during the study period. 117 (14.5%) had GA alone, 563 (70%) had GA with CEA, and 125 (15.5%) had SA. Duration of surgery was significantly longer for patients in the GA and CEA groups compared to the SA group, and more patients in the GA and CEA groups had a higher severity of hypospadias. We did not find significant differences in the odds ratio for postoperative complications between groups.Discussion: In our retrospective analysis, we did not find a difference between anesthetic groups in the rate of postoperative complications. Patients who had SA were younger and had a shorter median surgical time. Because SA has a limited duration, patients with more complicated pathologies may not be offered SA as an option. SA is an underutilized technique for pediatric urologic procedures, but has several benefits over GA for infants and young children.Conclusion: SA can be successfully utilized for hypospadias surgery in pediatric patients without an increase in postoperative complications. Future studies on this topic are warranted due to significant baseline differences between patient groups.Plain Language Summary: There has been debate about whether anesthetic choice during hypospadias surgery may affect the risk of postoperative surgical complications. Spinal anesthesia is a less commonly employed technique that numbs the lower body, allowing this type of surgery to be performed. However, there have been no studies that directly evaluate its association with complications following surgery.This study compared three anesthetic techniques (general anesthesia, general anesthesia with caudal nerve block, and awake spinal anesthesia) to determine if the incidence of postoperative complications differs between groups. We found that spinal anesthesia likely is not associated with more complications following surgery. It can be utilized safely and effectively as the primary anesthetic for infants and young children undergoing hypospadias repair for both simple and more complex pathologies.Keywords: pediatric anesthesia, spinal anesthesia, pediatric urology, hypospadias complications