Risk factors for respiratory complications after adenotonsillectomy in children with obstructive sleep apnea

Abstract

OBJECTIVE: To identify risk factors for respiratory complications after adenotonsillectomy in children ≤ 12 years of age with obstructive sleep apnea who were referred to the pediatric ICU (PICU). METHODS: A cross-sectional historical cohort study analyzing 53 children after adenotonsillectomy who met predetermined criteria for PICU referral in a tertiary level teaching hospital. The Student's t-test, Mann-Whitney test, and chi-square test were used to identify risk factors. RESULTS: Of the 805 children undergoing adenotonsillectomy between January of 2006 and December of 2012 in the teaching hospital, 53 were referred to the PICU. Twenty-one children (2.6% of all those undergoing adenotonsillectomy and 39.6% of those who were referred to the PICU) had respiratory complications. Of those 21, 12 were male. The mean age was 5.3 ± 2.6 years. A high apnea-hypopnea index (AHI; p = 0.0269), a high oxygen desaturation index (ODI; p = 0.0082), a low SpO2 nadir (p = 0.0055), prolonged orotracheal intubation (p = 0.0011), and rhinitis (p = 0.0426) were found to be independent predictors of respiratory complications. Some of the complications observed were minor (SpO2 90-80%), whereas others were major (SpO2 ≤ 80%, laryngospasm, bronchospasm, acute pulmonary edema, pneumonia, and apnea). CONCLUSIONS: Among children up to 12 years of age with OSA, those who have a high AHI, a high ODI, a low SpO2 nadir, or rhinitis are more likely to develop respiratory complications after adenotonsillectomy than are those without such characteristics.

Identificação de fatores de risco para apneia obstrutiva do sono após adenotonsilectomia: estudo piloto

“…A internação tende a ser breve, embora algumas crianças são mantidas internadas e em observação por alguma complicação no período imediato após a cirurgia [17][18][19][20] , sendo que a taxa de complicações varia de 2,6%, 5,8% à 8,8% 16,17,21 .…”

Impacts of disease severity on postoperative complications in children with sleep‐disordered breathing

“…23,[38][39][40][41][42][43][44][45][46][47][48][49][50][51] However, previous studies have compared differences in postoperative complications between children with and without OSA, without considering the effects of disease severity because of a limited sample size. [38][39][40][41][42][43][44][45][46][47][48][49][50][51] By contrast, this large, hospital-based study was the first to identify disparities in complications among children with primary snoring, mild OSA, and moderate-to-severe OSA. The present analytical results reveal that severe OSA increases perioperative respiratory complications, without increasing risks of major respiratory or bleeding complications.…”

“…However, considerable disparities exist in the incidence of respiratory complications and the method of defining it. [38][39][40][41][42][43][44][45][46][47][48][49][50] This study adopted different definitions of respiratory complications and classified the complications into perioperative and major respiratory complications. Perioperative respiratory complications are defined as oxygen saturation of less than 90%, 92%, or 95% in the recovery room, [38][39][40] and major respiratory complications include laryngospasm, bronchospasm, pulmonary edema, pneumonia, or endotracheal tube intubation at recovery stage.…”

“…Current studies have continually reported that OSA significantly increases postoperative respiratory complications in children. [38][39][40][41][42][43][44][45][46][47][48][49][50] Therefore, the American Academy of Otolaryngology-Head and Neck Surgery Foundation established clinical practice guidelines and recommends that clinicians should admit children with severe OSA following tonsillectomy. 55 The main findings of this study clarify that OSA increases the risk of perioperative respiratory complications in children, without increasing the risk of major respiratory complications.…”

Swallowing patterns after adenotonsillectomy in children

“…Although adenotonsillectomy is widely applied worldwide, the success rate is not 100%. Thus, it is essential to carefully consider the apnea‐hypopnea index (AHI), oxygen desaturation index (ODI), pulse oxygen saturation (SpO2) nadir and the presence of rhinitis and/or obesity to determine the best treatment with measurable benefits following treatment interventions …”