Anesthetic procedure outcomes after initial perioperative anaphylaxis: A retrospective multicenter US review

Background: Limited information exists regarding outcomes during repeat surgical procedures in patients with perioperative anaphylaxis (POA). Although current guidelines recommend that future procedures be guided by allergy evaluations, little is known about adherence to these recommendations or risk of recurrence. Objective: Our aim was to assess the incidence of recurrent POA and evaluate adherence to allergist recommendations during subsequent anesthetic procedures. Methods: We performed a retrospective review of 100 patients with POA across the Mayo Clinic Health System (2010-2021) to assess subsequent surgical procedures after allergy evaluation. Anesthetic records, allergy workup results, and allergist recommendations were reviewed. Results: Of 100 patients, 53 underwent at least 1 subsequent anesthetic procedure (median 2, range 1-7), with 81 anesthetic records available. No recurrent POA events were observed. A causative agent was identified in 25 patients (47%) as follows: antibiotics (n = 14), neuromuscular blocking agents (n = 5), and other agents (n = 8). Of the 38 procedures with records in this group, allergist recommendations were fully followed in 29 (76%) and partially followed in 9 (24%). In patients without an identified culprit (n = 28), 49 procedures had records, with partial adherence noted in 12 cases (18%). Deviations often involved substitution or avoidance of neuromuscular blocking agents, even when not implicated. Conclusion: Although no recurrence was observed, prospective studies are needed to determine whether adherence to allergist recommendations influences long-term outcomes, as well as to better understand documentation and communication practices.