Epilepsy Risk Associated With the Receipt of General Anesthesia Relative to Neuraxial Anesthesia
Bibliographic record
Abstract
BACKGROUND AND OBJECTIVES: Evidence suggests that the receipt of general anesthesia may be associated with an increased risk of epilepsy compared with neuraxial (i.e., spinal or epidural) anesthesia. Our study objective was to estimate the risk of developing new-onset epilepsy associated with the receipt of general anesthesia relative to neuraxial anesthesia. METHODS: We conducted a population-based retrospective cohort study using linked health administrative databases in Ontario, Canada. Participants who underwent an eligible surgical procedure with general or neuraxial anesthesia between April 1, 2007, and March 31, 2015, were included and followed for up to 5 years. Eligible surgical procedures included gynecologic, lower extremity, peripheral vascular, and urologic procedures that could be performed using general or neuraxial anesthesia. Patients with epilepsy or epilepsy risk factors in the 10 years before their surgical procedure were excluded. We used inverse probability of treatment weighting to control for confounding and Fine-Gray subdistribution models to estimate the hazard ratio for epilepsy, accounting for the competing risk of death. RESULTS: The final sample included 100,547 patients who received general anesthesia and 76,644 patients who received neuraxial anesthesia. After weighting, the general and neuraxial anesthesia cohorts comprised 64.8% and 63.0% of women and the mean ages were 56.0 and 56.8 years, respectively. The estimated weighted event rates of epilepsy were 48.8 and 35.5 per 100,000 person-years for general and neuraxial anesthesia cohorts, respectively. The hazard ratio (HR) for epilepsy associated with general anesthesia was 0.61 at time zero (95% CI 0.34-1.07). However, there was evidence that risk changed over the five-year follow-up period (time interaction HR = 1.36, 95% CI 1.12-1.64). This led to a significantly increased risk of epilepsy associated with general anesthesia after approximately 3 years. DISCUSSION: The effects of general anesthesia may take multiple years to become significantly associated with an increased risk of epilepsy. However, our findings are likely affected by other factors, such as unmeasured differences between the anesthesia cohorts, types of surgical procedures, and the occurrence of epilepsy risk factors during follow-up. Future research should explore whether there is effect modification between specific surgical procedures and control for the onset of epilepsy risk factors after anesthesia receipt.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".