Florence Julien-Marsollier1, Pierre Salis1, Rachida Abdat1, Thierno Diallo1, Thierry Van Den Abbelle2, Souhayl Dahmani3. 1. Department of Anaesthesia, Intensive care and Pain Management, Robert Debré University Hospital, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Paris Diderot University (Paris 7), Pres Paris Sorbonne Cité, 75000 Paris, France. 2. Paris Diderot University (Paris 7), Pres Paris Sorbonne Cité, 75000 Paris, France; Department of Ent-Nose and Throat Surgery, Robert Debré University Hospital, AP-HP, 75019 Paris, France; UMR Inserm U 676, Robert Debré University Hospital, 75019 Paris, France. 3. Department of Anaesthesia, Intensive care and Pain Management, Robert Debré University Hospital, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Paris Diderot University (Paris 7), Pres Paris Sorbonne Cité, 75000 Paris, France; Department of Ent-Nose and Throat Surgery, Robert Debré University Hospital, AP-HP, 75019 Paris, France. Electronic address: souhayl.dahmani@rdb.aphp.fr.
Abstract
INTRODUCTION: Tonsillectomy is considered as a therapeutic option in obstructive sleep apnoea syndrome (OSAS). Postoperative respiratory failure is a complication that can require respiratory support. The main objective of our study is to determine risk factors of postoperative respiratory complications in children undergoing tonsillectomy. MATERIAL AND METHODS: This is a retrospective single centre observational study including patients with unanticipated postoperative respiratory failure. Patients with a planned preoperative intensive care admission were excluded (age is lower than 2 years, overweight (>95% percentile of BMI), moderate or severe asthma, major medical conditions). Those patients were compared with randomly selected control patients. Factors studied were: age, weight, indication of surgery, ASA status, preoperative illness conditions, durations of surgery and anaesthesia and administered medications. Statistics used a univariate analysis and a multivariate logistic regression. RESULTS: Eight hundred and five patients underwent adenotonsillectomy during the study period and 25 developed postoperative respiratory failure. These patients were compared to 103 non-complicated control patients. Age (<4 years), weight (<18kg), indication of surgery (as SOAS), laryngomalacia, stable and minor congenital cardiac malformation and duration of anaesthesia were found statistically associated. Multivariate analysis found that weight <18kg is a risk factor associated with the occurrence of postoperative respiratory failure. Overall the model shows a strong accuracy with an area under the curve of ROC analysis of 0.9 [95% confidence interval: 0.85-0.95]. DISCUSSION: Our study found that weight <18kg is a major risk factor for predicting a postoperative respiratory complication.
INTRODUCTION: Tonsillectomy is considered as a therapeutic option in obstructive sleep apnoea syndrome (OSAS). Postoperative respiratory failure is a complication that can require respiratory support. The main objective of our study is to determine risk factors of postoperative respiratory complications in children undergoing tonsillectomy. MATERIAL AND METHODS: This is a retrospective single centre observational study including patients with unanticipated postoperative respiratory failure. Patients with a planned preoperative intensive care admission were excluded (age is lower than 2 years, overweight (>95% percentile of BMI), moderate or severe asthma, major medical conditions). Those patients were compared with randomly selected control patients. Factors studied were: age, weight, indication of surgery, ASA status, preoperative illness conditions, durations of surgery and anaesthesia and administered medications. Statistics used a univariate analysis and a multivariate logistic regression. RESULTS: Eight hundred and five patients underwent adenotonsillectomy during the study period and 25 developed postoperative respiratory failure. These patients were compared to 103 non-complicated control patients. Age (<4 years), weight (<18kg), indication of surgery (as SOAS), laryngomalacia, stable and minor congenital cardiac malformation and duration of anaesthesia were found statistically associated. Multivariate analysis found that weight <18kg is a risk factor associated with the occurrence of postoperative respiratory failure. Overall the model shows a strong accuracy with an area under the curve of ROC analysis of 0.9 [95% confidence interval: 0.85-0.95]. DISCUSSION: Our study found that weight <18kg is a major risk factor for predicting a postoperative respiratory complication.
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