Academic Performance in Adolescence after Inguinal Hernia Repair in Infancy: A Nationwide Cohort Study

Tom G Hansen, Jacob K Pedersen, Steen Winther Henneberg, Dorthe A Pedersen, Jeffrey C Murray, Neil S Morton, Kaare Christensen

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

BACKGROUND:: Although animal studies have indicated that general anesthetics may result in widespread apoptotic neurodegeneration and neurocognitive impairment in the developing brain, results from human studies are scarce. We investigated the association between exposure to surgery and anesthesia for inguinal hernia repair in infancy and subsequent academic performance. METHODS:: Using Danish birth cohorts from 1986-1990, we compared the academic performance of all children who had undergone inguinal hernia repair in infancy to a randomly selected, age-matched 5% population sample. Primary analysis compared average test scores at ninth grade adjusting for sex, birth weight, and paternal and maternal age and education. Secondary analysis compared the proportions of children not attaining test scores between the two groups. RESULTS:: From 1986-1990 in Denmark, 2,689 children underwent inguinal hernia repair in infancy. A randomly selected, age-matched 5% population sample consists of 14,575 individuals. Although the exposure group performed worse than the control group (average score 0.26 lower; 95% CI, 0.21-0.31), after adjusting for known confounders, no statistically significant difference (-0.04; 95% CI, -0.09 to 0.01) between the exposure and control groups could be demonstrated. However, the odds ratio for test score nonattainment associated with inguinal hernia repair was 1.18 (95% CI, 1.04-1.35). Excluding from analyses children with other congenital malformations, the difference in mean test scores remained nearly unchanged (0.05; 95% CI, 0.00-0.11). In addition, the increased proportion of test score nonattainment within the exposure group was attenuated (odds ratio = 1.13; 95% CI, 0.98-1.31). CONCLUSION:: In the ethnically and socioeconomically homogeneous Danish population, we found no evidence that a single, relatively brief anesthetic exposure in connection with hernia repair in infancy reduced academic performance at age 15 or 16 yr after adjusting for known confounding factors. However, the higher test score nonattainment rate among the hernia group could suggest that a subgroup of these children are developmentally disadvantaged compared with the background population.
Original languageEnglish
JournalAnesthesiology
Volume114
Issue number5
Pages (from-to)1076-85
ISSN0003-3022
DOIs
Publication statusPublished - 2011

Fingerprint

Inguinal Hernia
Herniorrhaphy
Cohort Studies
Population
Odds Ratio
Paternal Age
Control Groups
Maternal Age
Vulnerable Populations
Denmark
Education

Cite this

@article{6bcf44b19fe04422ad8cca8250de6df6,
title = "Academic Performance in Adolescence after Inguinal Hernia Repair in Infancy: A Nationwide Cohort Study",
abstract = "BACKGROUND:: Although animal studies have indicated that general anesthetics may result in widespread apoptotic neurodegeneration and neurocognitive impairment in the developing brain, results from human studies are scarce. We investigated the association between exposure to surgery and anesthesia for inguinal hernia repair in infancy and subsequent academic performance. METHODS:: Using Danish birth cohorts from 1986-1990, we compared the academic performance of all children who had undergone inguinal hernia repair in infancy to a randomly selected, age-matched 5{\%} population sample. Primary analysis compared average test scores at ninth grade adjusting for sex, birth weight, and paternal and maternal age and education. Secondary analysis compared the proportions of children not attaining test scores between the two groups. RESULTS:: From 1986-1990 in Denmark, 2,689 children underwent inguinal hernia repair in infancy. A randomly selected, age-matched 5{\%} population sample consists of 14,575 individuals. Although the exposure group performed worse than the control group (average score 0.26 lower; 95{\%} CI, 0.21-0.31), after adjusting for known confounders, no statistically significant difference (-0.04; 95{\%} CI, -0.09 to 0.01) between the exposure and control groups could be demonstrated. However, the odds ratio for test score nonattainment associated with inguinal hernia repair was 1.18 (95{\%} CI, 1.04-1.35). Excluding from analyses children with other congenital malformations, the difference in mean test scores remained nearly unchanged (0.05; 95{\%} CI, 0.00-0.11). In addition, the increased proportion of test score nonattainment within the exposure group was attenuated (odds ratio = 1.13; 95{\%} CI, 0.98-1.31). CONCLUSION:: In the ethnically and socioeconomically homogeneous Danish population, we found no evidence that a single, relatively brief anesthetic exposure in connection with hernia repair in infancy reduced academic performance at age 15 or 16 yr after adjusting for known confounding factors. However, the higher test score nonattainment rate among the hernia group could suggest that a subgroup of these children are developmentally disadvantaged compared with the background population.",
author = "Hansen, {Tom G} and Pedersen, {Jacob K} and Henneberg, {Steen Winther} and Pedersen, {Dorthe A} and Murray, {Jeffrey C} and Morton, {Neil S} and Kaare Christensen",
year = "2011",
doi = "10.1097/ALN.0b013e31820e77a0",
language = "English",
volume = "114",
pages = "1076--85",
journal = "Anesthesiology",
issn = "0003-3022",
publisher = "Lippincott Williams & Wilkins",
number = "5",

}

Academic Performance in Adolescence after Inguinal Hernia Repair in Infancy: A Nationwide Cohort Study. / Hansen, Tom G; Pedersen, Jacob K; Henneberg, Steen Winther; Pedersen, Dorthe A; Murray, Jeffrey C; Morton, Neil S; Christensen, Kaare.

In: Anesthesiology, Vol. 114, No. 5, 2011, p. 1076-85.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Academic Performance in Adolescence after Inguinal Hernia Repair in Infancy: A Nationwide Cohort Study

AU - Hansen, Tom G

AU - Pedersen, Jacob K

AU - Henneberg, Steen Winther

AU - Pedersen, Dorthe A

AU - Murray, Jeffrey C

AU - Morton, Neil S

AU - Christensen, Kaare

PY - 2011

Y1 - 2011

N2 - BACKGROUND:: Although animal studies have indicated that general anesthetics may result in widespread apoptotic neurodegeneration and neurocognitive impairment in the developing brain, results from human studies are scarce. We investigated the association between exposure to surgery and anesthesia for inguinal hernia repair in infancy and subsequent academic performance. METHODS:: Using Danish birth cohorts from 1986-1990, we compared the academic performance of all children who had undergone inguinal hernia repair in infancy to a randomly selected, age-matched 5% population sample. Primary analysis compared average test scores at ninth grade adjusting for sex, birth weight, and paternal and maternal age and education. Secondary analysis compared the proportions of children not attaining test scores between the two groups. RESULTS:: From 1986-1990 in Denmark, 2,689 children underwent inguinal hernia repair in infancy. A randomly selected, age-matched 5% population sample consists of 14,575 individuals. Although the exposure group performed worse than the control group (average score 0.26 lower; 95% CI, 0.21-0.31), after adjusting for known confounders, no statistically significant difference (-0.04; 95% CI, -0.09 to 0.01) between the exposure and control groups could be demonstrated. However, the odds ratio for test score nonattainment associated with inguinal hernia repair was 1.18 (95% CI, 1.04-1.35). Excluding from analyses children with other congenital malformations, the difference in mean test scores remained nearly unchanged (0.05; 95% CI, 0.00-0.11). In addition, the increased proportion of test score nonattainment within the exposure group was attenuated (odds ratio = 1.13; 95% CI, 0.98-1.31). CONCLUSION:: In the ethnically and socioeconomically homogeneous Danish population, we found no evidence that a single, relatively brief anesthetic exposure in connection with hernia repair in infancy reduced academic performance at age 15 or 16 yr after adjusting for known confounding factors. However, the higher test score nonattainment rate among the hernia group could suggest that a subgroup of these children are developmentally disadvantaged compared with the background population.

AB - BACKGROUND:: Although animal studies have indicated that general anesthetics may result in widespread apoptotic neurodegeneration and neurocognitive impairment in the developing brain, results from human studies are scarce. We investigated the association between exposure to surgery and anesthesia for inguinal hernia repair in infancy and subsequent academic performance. METHODS:: Using Danish birth cohorts from 1986-1990, we compared the academic performance of all children who had undergone inguinal hernia repair in infancy to a randomly selected, age-matched 5% population sample. Primary analysis compared average test scores at ninth grade adjusting for sex, birth weight, and paternal and maternal age and education. Secondary analysis compared the proportions of children not attaining test scores between the two groups. RESULTS:: From 1986-1990 in Denmark, 2,689 children underwent inguinal hernia repair in infancy. A randomly selected, age-matched 5% population sample consists of 14,575 individuals. Although the exposure group performed worse than the control group (average score 0.26 lower; 95% CI, 0.21-0.31), after adjusting for known confounders, no statistically significant difference (-0.04; 95% CI, -0.09 to 0.01) between the exposure and control groups could be demonstrated. However, the odds ratio for test score nonattainment associated with inguinal hernia repair was 1.18 (95% CI, 1.04-1.35). Excluding from analyses children with other congenital malformations, the difference in mean test scores remained nearly unchanged (0.05; 95% CI, 0.00-0.11). In addition, the increased proportion of test score nonattainment within the exposure group was attenuated (odds ratio = 1.13; 95% CI, 0.98-1.31). CONCLUSION:: In the ethnically and socioeconomically homogeneous Danish population, we found no evidence that a single, relatively brief anesthetic exposure in connection with hernia repair in infancy reduced academic performance at age 15 or 16 yr after adjusting for known confounding factors. However, the higher test score nonattainment rate among the hernia group could suggest that a subgroup of these children are developmentally disadvantaged compared with the background population.

U2 - 10.1097/ALN.0b013e31820e77a0

DO - 10.1097/ALN.0b013e31820e77a0

M3 - Journal article

VL - 114

SP - 1076

EP - 1085

JO - Anesthesiology

JF - Anesthesiology

SN - 0003-3022

IS - 5

ER -