Analysis Of The Risk Factors Of Perioperative Anaphylaxis And The Preventive Effect Of Anti-allergy Premedication

ObjectivePerioperative anaphylaxis is rare but often be life-threatening.How to assess the high-risk patient susceptible to perioperative anaphylaxis and effectively prevent perioperative anaphylaxis become increasingly important.The retrospective study was used to analyze the risk factors of perioperative anaphylaxies and the prophylactic effects of anti-allergy premedication on perioperative anaphylaxis and the factors associated with anti-allergy premedication options in surgical patient.This study aimed to provide clinical evidence and guidance to early identify high-risk patient and find more effective preventive measures for perioperative anaphylaxis.MethodsThe identified surgical patients were included between Oct.1,2012 and Dec.31,2017 in the First Affiliated Hospital of Chongqing Medical University.The study was divided into two parts: in part one,the retrospective nested case-control study was used to identify the risk factors of perioperative anaphylaxis.The case groups covered surgical patients who had experienced perioperative anaphylaxis,and the control groups covered surgical patients who had not developed an allergic reaction on the day of surgery.Four control patients were individually matched to one case patient based on the same date of operation and age around 5 years for the study cohort of perioperative anaphylaxis.Univariate logistic regression analysis was used to identify the potential risk factors of perioperative anaphylaxis and the further multivariable logistic regression analysis was used in case it was shown univariate association with perioperative anaphylaxis at the 10% significance level.In part two,the surgical patients with high-risk anaphylaxis were included,in which patients who had previously experienced anaphylaxis with unidentified culprits,had been given anti-allergy premedication prior to the operation according to the degree of risk and severity of anaphylaxis.Descriptive statistics were used to analyze the prophylactic effects of anti-allergy premedication;Univariate and multivariable logistic regression analysis were used to identify factors associated with anti-allergy premedication options.ResultsThe first part of nested case-control study showed that history of allergic diseases,history of drug allergy,history of allergies to food or other substances,orthopedic surgery and vascular surgery were risk factors of perioperative anaphylaxis by univariate logistic regression analysis.It was found by further multivariable logistic analysis that the independent risk factors of perioperative anaphylaxis were history of drug allergy(OR 6.78;95% CI,2.35–19.54;P < 0.01)and history of allergies to food or other substances(OR 40.56;95% CI,8.12–202.52;P < 0.01).Compared with abdominal surgery,orthopedic surgery(OR 3.03;95% CI,1.06–8.63;P = 0.04)and vascular surgery(OR 16.56;95% CI,2.95–92.90;P < 0.01)showed increased risk with perioperative anaphylaxis.The second part of the prophylactic effects of anti-allergy premedication study showed that there were 93 patients with high-risk perioperative anaphylaxis patients,in which 58 patients had been given anti-allergy premedication prior to the operation and the rest had been prevented re-exposure of suspected drug allergens.None of 93 patients developed anaphylaxis during the surgical procedure.By univariate analysis,it was found that history of allergic diseases,more than two allergens to food or other substances,history of grade Ⅱ or grade Ⅲ perioperative anaphylaxis,orthopedic surgery,using angiotensin converting anzyme inhibitor were related to anti-allergy premedication options.By multivariate logistic analysis,it was found that history of grade Ⅱ or grade Ⅲ perioperative anaphylaxis(OR 9.09;95% CI,1.34–61.55;P = 0.02)was identified as risk factor associated with anti-allergy premedication options in high-risk perioperative anaphylaxis patients.ConclusionsIt was found that history of drug allergy,history of allergies to food or other substances,orthopedic surgery and vascular surgery were the independent risk factors for perioperative anaphylaxis.It was verified that effective prophylactic measures of perioperative anaphylaxis for surgical patients with high-risk factors by avoiding culprit drugs or taking rational anti-allergy premedication.It was shown that history of grade Ⅱ or grade Ⅲ perioperative anaphylaxis was associated with anti-allergy premedication options in high-risk perioperative anaphylaxis patients.