OBJECTIVE: A pilot study to identify risk factors predicting post-operative complications in children with severe OSA undergoing adenotonsillectomy. METHODS: Retrospective review in a tertiary care academic institution. Two-stage least squares regression analysis and instrumental variable analysis to allow for modeling of pre- and peri-operative risk factors as having significance in predicting post-operative morbidity. RESULTS: Eighty-three children (mean age 4.88 ± 3.09 years) with apnea-hypopnea index (AHI) ≥ 10 who were observed overnight following adenotonsillectomy were evaluated for rates of major (increased level of care, CPAP/BiPAP use, pulmonary edema and reintubation) and minor (oxygen saturation <90%) airway complications as well as total observation costs. Major and minor complications occurred in 4.8% and 19.3% of children, respectively. Age <2 years (p<0.01), AHI >24 (p<0.05), intra-operative laryngospasm requiring treatment (p<0.05), oxygen saturations <90% on room air in PACU (p<0.05) and PACU stay >100 min (p<0.01) independently predicted post-operative complications. Children with any one of these factors experienced a 38% complication rate versus 4% in all others. CONCLUSIONS: This pilot study identified pre- and peri-operative risk factors that collectively can be investigated as predictors of post-operative airway complications in a prospective study. By identifying preliminary results comparing the complication rates between those children with and without these risk factors, we will be able to calculate the sample size for a future prospective validation study. Such a study is necessary to understand the safety and potential significant cost savings of observing children without risk factors on the pediatric floor and not in an ICU setting. A best practice algorithm can be created for children with severe OSA only after completing this prospective study.
OBJECTIVE: A pilot study to identify risk factors predicting post-operative complications in children with severe OSA undergoing adenotonsillectomy. METHODS: Retrospective review in a tertiary care academic institution. Two-stage least squares regression analysis and instrumental variable analysis to allow for modeling of pre- and peri-operative risk factors as having significance in predicting post-operative morbidity. RESULTS: Eighty-three children (mean age 4.88 ± 3.09 years) with apnea-hypopnea index (AHI) ≥ 10 who were observed overnight following adenotonsillectomy were evaluated for rates of major (increased level of care, CPAP/BiPAP use, pulmonary edema and reintubation) and minor (oxygen saturation <90%) airway complications as well as total observation costs. Major and minor complications occurred in 4.8% and 19.3% of children, respectively. Age <2 years (p<0.01), AHI >24 (p<0.05), intra-operative laryngospasm requiring treatment (p<0.05), oxygen saturations <90% on room air in PACU (p<0.05) and PACU stay >100 min (p<0.01) independently predicted post-operative complications. Children with any one of these factors experienced a 38% complication rate versus 4% in all others. CONCLUSIONS: This pilot study identified pre- and peri-operative risk factors that collectively can be investigated as predictors of post-operative airway complications in a prospective study. By identifying preliminary results comparing the complication rates between those children with and without these risk factors, we will be able to calculate the sample size for a future prospective validation study. Such a study is necessary to understand the safety and potential significant cost savings of observing children without risk factors on the pediatric floor and not in an ICU setting. A best practice algorithm can be created for children with severe OSA only after completing this prospective study.
Authors: Sofia Konstantinopoulou; Paul Gallagher; Lisa Elden; Susan L Garetz; Ron B Mitchell; Susan Redline; Carol L Rosen; Eliot S Katz; Ronald D Chervin; Raouf Amin; Raanan Arens; Shalini Paruthi; Carole L Marcus Journal: Int J Pediatr Otorhinolaryngol Date: 2014-12-22 Impact factor: 1.675
Authors: Sherri L Katz; Andrea Monsour; Nicholas Barrowman; Lynda Hoey; Matthew Bromwich; Franco Momoli; Theodora Chan; Reuben Goldberg; Abhilasha Patel; Li Yin; Kimmo Murto Journal: J Clin Sleep Med Date: 2019-11-27 Impact factor: 4.062
Authors: Anchana Thongyam; Carole L Marcus; Justin L Lockman; Mary Anne Cornaglia; Aviva Caroff; Paul R Gallagher; Justine Shults; Joel T Traylor; Mark D Rizzi; Lisa Elden Journal: Otolaryngol Head Neck Surg Date: 2014-10-09 Impact factor: 3.497