Postoperative Respiratory Complications After Adenotonsillectomy in Children With High-Risk Obstructive Sleep Apnea.

Publisher: Wiley Country of Publication: England NLM ID: 8508176 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-6817 (Electronic) Linking ISSN: 01945998 NLM ISO Abbreviation: Otolaryngol Head Neck Surg Subsets: MEDLINE

Publication: 2023- : [Oxford] : Wiley
Original Publication: [Rochester, Minn.] : The Academy, [c1981-

Sleep Apnea, Obstructive*/surgery ; Tonsillectomy*/adverse effects ; Adenoidectomy*/adverse effects ; Postoperative Complications*/epidemiology ; Postoperative Complications*/etiology ; Polysomnography*; Humans ; Male ; Female ; Child ; Child, Preschool ; Retrospective Studies ; Risk Factors ; Length of Stay ; Adolescent

Objective: Identify patient characteristics and polysomnogram (PSG) parameters associated with postoperative respiratory complications after adenotonsillectomy (AT) among children with high-risk obstructive sleep apnea (OSA).
Study Design: Case series with chart review.
Setting: Tertiary care children's hospital.
Methods: Pediatric patients (<18 years) with high-risk OSA (any 1 of: apnea-hypopnea index [AHI] >30, O 2 nadir <80% and peak CO 2  >60 mm Hg) on overnight PSG from 2019 to 2021 were included. Primary outcomes were major respiratory intervention during the postoperative admission, prolonged hospitalization, and intensive care unit (ICU) stay.
Results: A total of 307 patients met inclusion criteria. Median age was 6.5 years and 63% were male. Twenty-five (8.1%) required major respiratory intervention and 29 (9.7%) required ICU admission after AT. Major interventions and ICU admissions were significantly associated with neuromuscular disease (P < .01), higher obstructive apnea-hypopnea index (oAHI), higher CO 2 peak, and lower O 2 nadir. Prolonged admission had similar findings except oAHI was not significantly associated. Younger children were significant more likely to require ICU admission or prolonged admission.
Conclusion: Increased oAHI and worsening O 2 and CO 2 parameters on preoperative PSG were associated with postoperative respiratory complications in children with high-risk OSA. Children with neuromuscular disease and age 0 to 2 had higher risk of ICU stay and prolonged hospitalization. Clinicians should recognize the importance of parameters beyond oAHI when anticipating postoperative monitoring.
(© 2024 The Author(s). Otolaryngology–Head and Neck Surgery published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology–Head and Neck Surgery Foundation.)

J Biomed Inform. 2009 Apr;42(2):377-81. (PMID: 18929686)
Laryngoscope. 2023 May;133(5):1251-1256. (PMID: 35932233)
Int J Pediatr Otorhinolaryngol. 2022 Jul;158:111166. (PMID: 35567809)
Laryngoscope. 2019 Apr;129(4):995-1000. (PMID: 30412279)
Int J Pediatr Otorhinolaryngol. 2020 Jan;128:109693. (PMID: 31568955)
Otolaryngol Head Neck Surg. 2019 Feb;160(2):187-205. (PMID: 30921525)
Pediatrics. 2012 Sep;130(3):576-84. (PMID: 22926173)
Otolaryngol Head Neck Surg. 2023 Jun;168(6):1535-1544. (PMID: 36939624)
Int J Pediatr Otorhinolaryngol. 2017 Jul;98:136-142. (PMID: 28583490)
Am J Respir Crit Care Med. 2010 Sep 1;182(5):676-83. (PMID: 20448096)
Int J Surg. 2014 Dec;12(12):1495-9. (PMID: 25046131)

Keywords: high‐risk sleep apnea; obstructive sleep apnea; postoperative complications; profound sleep apnea; very severe sleep apnea

Date Created: 20240828 Date Completed: 20241129 Latest Revision: 20241201

20241202

PMC11605024

10.1002/ohn.961

39194366