Pediatric dental treatment under general anesthesia at a regional center on Jeju Island: a retrospective comparison of healthy patients and patients with special health care needs

Background: Pediatric patients with dental anxiety, behavioral difficulties, or special health care needs (SHCN) may require general anesthesia (GA), and Jeju Island’s geographic isolation limits specialist access. We compared treatment patterns, perioperative outcomes, and preanesthetic evaluation between Healthy and SHCN patients, and whether differences persisted after case-mix adjustment. Methods: This retrospective study included all pediatric patients treated under GA at Jeju National University Hospital between January 2018 and June 2025. Costs are reported in Korean Won (KRW). Primary analyses used multivariable linear regression for log-transformed outcomes and logistic regression for incomplete evaluation, adjusted for age, sex, treatment category, and number of teeth treated; unadjusted comparisons were descriptive. Results: Of 402 GA sessions in 370 patients (median age, 6.0 years; 66.4% male), 235 (58.5%) involved SHCN patients. Operative time (118.0 in Healthy vs. 143.0 min in SHCN; p = 0.012), anesthesia time (153.0 vs. 185.0 min; p = 0.001), and cost (1,688,204 vs. 1,851,082 KRW; p < 0.001) were higher in SHCN sessions, but these differences were not evident after adjustment (−9.3%, p = 0.065; −4.9%, p = 0.220; +3.1%, p = 0.440). The induction and emergence interval remained 12.0% longer and incomplete preanesthetic evaluation more frequent (14.4% vs. 46.0%; adjusted odds ratio 4.20); both p < 0.001. Repeat GA was also more common in SHCN patients (0.6% vs. 14.2%; p < 0.001). Incomplete evaluation clustered in the two dental severe disability subgroups (52.1% and 48.8%) versus medical comorbidity alone (3.7%). Postoperative complications occurred in 0.5% of sessions. Conclusions: Pediatric dental GA at this center had a low complication rate. Longer unadjusted operative and anesthesia times and higher costs in SHCN patients were largely explained by the greater extent and composition of treatment. The SHCN-associated burden was more apparent in anesthetic transition time, incomplete preanesthetic evaluation, and repeat GA.

General anesthesia; Pediatric dentistry; Special health care needs; Retrospective study; Jeju Island

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