Prevalence of malignant hyperthermia diagnosis in obstetric patients in the United States, 2003 to 2014

Abstract

Background: The cost-benefit of stocking dantrolene in maternity units for treating malignant hyperthermia (MH) has been recently questioned because of the low incidence of MH crisis in the general population and the low utilization of general anesthesia in obstetrics. However, no study has examined the prevalence of MH susceptibility in obstetrics. This study aimed to assess the prevalence of MH diagnosis and associated factors in obstetric patients. Methods: Data for this study came from the National Inpatient Sample from 2003 to 2014, a 20% nationally representative sample of discharge records from community hospitals. A diagnosis of MH due to anesthesia was identified using the International Classification of Diseases, Ninth Revision, Clinical Modification code 995.86. MH prevalence was estimated according to the delivery mode and patient and hospital characteristics. Results: During the 12-year study period, 47,178,322 delivery-related discharges [including 15,175,127 (32.2%) cesarean deliveries] were identified. Of them, 215 recorded a diagnosis of MH, yielding a prevalence of 0.46 per 100, 000 [95% confidence interval (CI), 0.40 to 0.52]. The prevalence of MH diagnosis in cesarean deliveries was 0.81 per 100,000 (95% CI, 0.67 to 0.97), compared with 0.29 per 100,000 (95% CI, 0.23 to 0.35) in vaginal deliveries (P < 0.001). Multivariable logistic regression revealed that cesarean delivery was associated with a significantly increased risk of MH diagnosis [adjusted rate ratio (aOR) 2.88; 95% CI, 2.19 to 3.80]. Prevalence of MH diagnosis was lower in Hispanics than in non-Hispanic whites (aOR 0.47; 95% CI, 0.29 to 0.76) and higher in the South than in the Northeast census regions (aOR 2.44; 95% CI, 1.50 to 3.96). Conclusion: The prevalence of MH-susceptibility is about 1 in 125,000 in cesarean deliveries, similar to the prevalence reported in non-obstetrical surgery inpatients. The findings of this study suggest that stocking dantrolene in maternity units is justified.

Clinical Features of Suspected Malignant Hyperthermia in China from 2015 to 2020: A Retrospective Study from China Malignant Hyperthermia Emergency Assistance Group

“…The fact is far away from the recommendation of the MHAUS that dantrolene should be immediately available (for administration within 10min) in operating room areas. 27 , 28 Indeed, as the only disease-specific drug available for MH, lack of IV dantrolene in most Chinese hospitals is the major problem in MH treatment. 14 , 29 Only few hospitals in China stored IV dantrolene because of the high cost and low utilization.…”

Epidemiological and clinical features of malignant hyperthermia: A scoping review

“…4,6 The results from the last decade of research are similar to previous studies, with a prevalence of MH diagnosis arranging from 0.18 per 100 000 to 3.9 per 100 000. [20][21][22][23][24] As a rare disease, the overall reported incidence of MH varied widely in different studies because of many factors. Studies have shown that general anesthesia was more likely to cause MH than other types of anesthesia.…”

“…24 Obstetric patients, especially during vaginal delivery, usually had a lower incidence of MH, at 0.29 per 100 000. 23…”

“…22,26,28,45 The incidence of MH varied among different ethnic groups, which might be caused by different genetic backgrounds. 22,23,28,29,38…”

Anaesthetic management of a parturient patient with a malignant hyperthermia partner

“…Presentation within the child population is similar to adults, with muscle rigidity, hypermetabolism and arrhythmias, and neonatal presentation is likely to fall under the same umbrella. Estimated incidence in the general surgical population is between 1:3000 to 1:100 000 and 1:125 000 in the US obstetric population 2 3…”