Incidence of and risk factors for perioperative or periprocedural anaphylaxis in the United States from 2005 to 2014

Background: The estimated worldwide incidence of perioperative or periprocedural anaphylaxis (PA) is between 1 in 1250 and 1 in 20,000 procedures. Objective: To evaluate the incidence of PA in the United States and compare patient characteristics and underlying risk factors using a large national database. Methods: Using deidentified data from the nationwide inpatient sample from 2005 to 2014, we identified cases of PA through the International Classification of Diseases, Ninth Revision, Clinical Modification codes and conducted a retrospective analysis. Results: Among 35,647,347 surgeries and procedures, there were 5458 (0.015%) PA cases identified. The incidence of PA was 15.3 cases per 100,000 procedures. When compared with controls, PA cases had an increased mortality (3.4% vs 1.4%; P <.001), median length of stay (5 vs 3 days; P <.001), and median hospital cost ($45,155 vs $24,734; P <.001). The age group between 18 and 34 years (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.13-1.58; P <.001) and female sex (OR, 1.40; 95% CI, 1.31-1.49; P <.001) were associated with increased odds of PA. Transplant (OR, 3.35; 95% CI, 2.59-4.34; P <.001), hematologic (OR, 1.63; 95% CI, 1.30-2.05; P <.001), vascular (OR, 1.49; 95% CI, 1.30-1.67; P <.001), and cardiac (OR, 1.47; 95% CI, 1.30-1.67; P <.001) procedures were at increased risk for PA. Several comorbidities were associated with PA including chronic pulmonary disease (OR, 1.41; 95% CI, 1.31-1.51; P <.001). Conclusion: The incidence of PA is 1 in 6531 procedures, with a mortality of 1 in 191,652 procedures. PA has worsening outcomes compared with controls. The risk factors of PA include age, sex, procedure type, and comorbidities.