Dental treatment outcomes under general anesthesia in pediatric patients with and without autism spectrum disorder: A retrospective analysis

This study compared perioperative dental treatment outcomes under general anesthesia (GA) between children with autism spectrum disorder (ASD) and neurotypical peers, focusing on treatment duration, complication rates, and clinical predictors. This retrospective comparative study analyzed records of 160 children aged 5 to 12 years who underwent dental treatment under GA at a university hospital in Turkey (January 2023-May 2025). The ASD group (n = 80) included patients diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), while the control group (n = 80) comprised age- and sex-matched neurotypical children requiring GA due to cooperation difficulties. Data included demographic variables, American Society of Anesthesiologists (ASA) classification, caries indices (dmft/DMFT), GA and operative durations, types of procedures, and perioperative complications. Statistical analyses used the Shapiro-Wilk, Mann-Whitney U, and chi-square/Fisher exact tests, with multivariable regression to identify predictors. Effect sizes (Cohen d) and 95% confidence intervals (CI) were calculated. ASD patients were older (8.20 ± 1.79 vs 5.27 ± 1.29 years, P < .001; Cohen d = 1.79, 95% CI: 1.38-2.20) and more often ASA II (64.2% vs 24.1%, P < .001). They had lower dmft but higher DMFT scores (P < .001). GA and treatment durations were shorter in the ASD group (GA: 120 vs 155 minutes, Cohen d = 0.75; treatment: 85 vs 130 minutes, Cohen d = 0.72; both P < .001), reflecting fewer treated teeth (11.5 ± 2.9 vs 14.1 ± 3.2; P < .001). Perioperative complications were higher among ASD patients (32.1% vs 7.6%; odds ratio = 5.7, 95% CI: 2.0-15.0; P < .001), most commonly bradycardia, nausea, and emergence agitation. Multivariable regression identified ASA II status and caries burden - but not ASD diagnosis - as independent predictors of prolonged GA and treatment times. Children with ASD had shorter GA durations but significantly higher perioperative complication rates. ASA II status and caries burden predicted longer operative times. These findings emphasize the need for ASD-specific perioperative protocols, preventive strategies, and multidisciplinary care.