David Kasle1, Jordan Virbalas2, John P Bent3, Jeffrey Cheng4. 1. Albert Einstein College of Medicine, Bronx, NY, USA. 2. University of Colorado, Pediatric Otolaryngology Fellow, Denver, CO, USA. 3. Albert Einstein College of Medicine, Bronx, NY, USA; Otolaryngology - Head and Neck Surgery, Montefiore Medical Center, Bronx, NY, USA. 4. Pediatric Otolaryngology, Department of Surgery, Division of Otolaryngology - Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, NC, USA. Electronic address: jeffrey.cheng@duke.edu.
Abstract
OBJECTIVE: To identify predictors of post-operative respiratory complications in children undergoing tonsillectomy. METHODS: Consecutive case series with chart review of children who underwent polysomnography (PSG) and subsequent tonsillectomy with or without adenoidectomy for obstructive sleep apnea (OSA). Patients with craniofacial anomalies or significant cardiopulmonary comorbidities were excluded. Rates of post-surgical respiratory complication were reviewed and compared to patient specific factors and PSG findings to identify possible risk factors. RESULTS: Eighty-six patients (mean age 5.3 ± 2.2 years) were included. There was a statistically significant (p = 0.03) relationship between an AHI ≥40 (AHI40) and post-operative respiratory complications. AHI40 also had the greatest magnitude of association with postoperative respiratory complications (OR = 5.313). An AHI ≥25 (AHI25) was marginally significant (p = 0.067). No significant difference in outcome occurrence was found when analyzing rates of complication in patients with BMI above and below 18 (p = 0.20) or oxygen (O2) nadir above and below 80% (p = 0.09). The AHI ranged from 0 to 112.2, and no postoperative respiratory complications were identified in children with an AHI less than 10. CONCLUSIONS: Our results indicate an association between an AHI ≥40 and respiratory complications following an adenotonsillectomy, but we were not able to observe any significant difference at a cutoff of 25. An association between BMI or O2 nadir and postoperative respiratory complication was not able to be identified. Our results support the importance of AHI as a predictor of postoperative respiratory complications in children undergoing tonsillectomy for OSA.
OBJECTIVE: To identify predictors of post-operative respiratory complications in children undergoing tonsillectomy. METHODS: Consecutive case series with chart review of children who underwent polysomnography (PSG) and subsequent tonsillectomy with or without adenoidectomy for obstructive sleep apnea (OSA). Patients with craniofacial anomalies or significant cardiopulmonary comorbidities were excluded. Rates of post-surgical respiratory complication were reviewed and compared to patient specific factors and PSG findings to identify possible risk factors. RESULTS: Eighty-six patients (mean age 5.3 ± 2.2 years) were included. There was a statistically significant (p = 0.03) relationship between an AHI ≥40 (AHI40) and post-operative respiratory complications. AHI40 also had the greatest magnitude of association with postoperative respiratory complications (OR = 5.313). An AHI ≥25 (AHI25) was marginally significant (p = 0.067). No significant difference in outcome occurrence was found when analyzing rates of complication in patients with BMI above and below 18 (p = 0.20) or oxygen (O2) nadir above and below 80% (p = 0.09). The AHI ranged from 0 to 112.2, and no postoperative respiratory complications were identified in children with an AHI less than 10. CONCLUSIONS: Our results indicate an association between an AHI ≥40 and respiratory complications following an adenotonsillectomy, but we were not able to observe any significant difference at a cutoff of 25. An association between BMI or O2 nadir and postoperative respiratory complication was not able to be identified. Our results support the importance of AHI as a predictor of postoperative respiratory complications in children undergoing tonsillectomy for OSA.
Authors: Claire M Lawlor; Charles A Riley; John M Carter; Kimsey H Rodriguez Journal: JAMA Otolaryngol Head Neck Surg Date: 2018-05-01 Impact factor: 6.223
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