Adenoidectomy: Inpatient criteria study

Patel, Ravi R.; Patel, Neha A.; Stoffels, Guillaume; Silverman, Joshua B.; Smith, Lee P.

doi:10.1016/j.amjoto.2020.102765

Cited by 4 publications

(12 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Another single institution study also demonstrated that all patients with post-operative interventions or complications were 18 months of age and younger. 23 Our present study did not find age to significantly impact the risk of post-operative hemorrhage, however, age less than 18 months was predictive of post-operative respiratory distress.…”

Section: Discussioncontrasting

confidence: 81%

“…These data also indicate that patient comorbidities impact post-operative complications and interventions following adenoidectomy. Patel et al 23 found increased rates of post-operative complications and interventions among children with chronic lung disease, reactive airway disease, craniofacial syndrome, neuromuscular disorder, seizure, severe sleep apnea, and prematurity. While Patel et al classified all complications together comprising of readmission, bleeding, dehydration, and intubation, our study made a distinction between post-operative respiratory distress and post-operative bleeding.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A National Analysis of Inpatient Pediatric Adenoidectomy

Yan

Huang

Nguyen

et al. 2022

Ann Otol Rhinol Laryngol

View full text Add to dashboard Cite

Objective: Hospital admission following pediatric adenoidectomy without tonsillectomy is not well characterized. The objective of our study is to better characterize risk factors for post-operative complications in younger children undergoing inpatient adenoidectomy. Methods: A cross-sectional analysis using data derived from the Kid’s Inpatient Database (KID) was performed. Study participants included children <3 years of age who underwent an adenoidectomy and were admitted to hospitals participating in the KID for years 1997, 2000, 2003, 2006, 2009, and 2012. Descriptive statistical analysis and a multivariate logistic regression analysis were performed to identify risk factors for post-operative complication. Results: A total of 3406 children (mean age 1.1 ± 0.7 years) were included. The overall post-operative bleeding and respiratory complication rates were 0.6% and 5.4%, respectively. Children less than 18 months of age demonstrated increased rates of post-operative respiratory complications ( P = .009), but not bleeding complications ( P = .857). Presence of cardiopulmonary congenital malformations (OR 1.54, 95% CI 1.07-2.20), chronic respiratory disease of the newborn (OR 5.03, 95% CI 2.86-8.85), and neuromuscular disorders (OR 1.97, 95% CI 1.09-3.57) were associated with post-operative respiratory distress. Conclusions: This analysis of a national dataset suggests that otherwise healthy children less than 18 months of age and children 18 months to 3 years of age with certain comorbidities may benefit from overnight observation following adenoidectomy.

show abstract

Section: Discussioncontrasting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

A National Analysis of Inpatient Pediatric Adenoidectomy

Yan

Huang

Nguyen

et al. 2022

Ann Otol Rhinol Laryngol

View full text Add to dashboard Cite

show abstract

“…Nine studies 16,18,19,23,25–28,32 with sufficient data on major PoRCs were examined. No significant difference was found in the rate of major PoRCs in pediatric patients with OSA compared to children without it ( p = 0.200, OR: 2.14, 95% CI [0.67, 6.86]) ( I 2 61.7%, χ 2 test p = 0.008) (Figure 4), suggesting that OSA does not elevate the risk for major respiratory complications postoperatively.…”

Section: Resultsmentioning

confidence: 99%

“…A statistical analysis of four studies 20,21,23,25 showed no significant differences ( p = 0.669, OR: 1.29, 95% CI [0.40, 4.14]) in additional comorbidities in children with OSA compared to children without it in the PoRCs group (Figure 5). Based on our results, the presence of other comorbidities was not more common in the OSA group among pediatric patients with respiratory complications postoperatively, strengthening our hypothesis that OSA alone can increase the risk of respiratory complications after AT surgery.…”

Section: Resultsmentioning

confidence: 99%

“…Most of the studies are retrospective and did not examine the exact same population or provide sufficient data on the population under examination or any complications. However, all of the included studies used the same classification for moderate and severe OSA (moderate OSA: AHI 5–10; severe OSA: AHI>>10), although the criteria for the diagnosis were different in some of them (mild OSA: AHI 1–5 according to Dalesio 16 and Kang 18 ; AHI 2–5 according to Ekstein 17 and Rodriguez‐Catalán 23 ; and AHI 3–5 according to Camacho) 14 . Still, since the appearance rate of PoRCs showed no significant difference in mild OSA compared to non‐OSA patients, no further modification was required.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The risk of postoperative respiratory complications following adenotonsillar surgery in children with or without obstructive sleep apnea: A systematic review and meta‐analysis

Keserű

Sipos

Farkas

et al. 2022

Pediatric Pulmonology

View full text Add to dashboard Cite

Objectives Obstructive sleep apnea (OSA) appears in 2%–5% of children, with first‐line treatment being adenotonsillar (AT) surgery. Our aim was to examine the risk of postoperative respiratory complications (PoRCs) in non‐OSA and the different OSA severity (mild, moderate, severe) groups. Study Design We conducted a systematic review and meta‐analysis of studies comparing PoRCs following AT surgery in children with and without OSA. Methods Nineteen observational studies were identified with the same search key used in MEDLINE, Embase, and CENTRAL. The connection between PoRCs, the presence and severity of OSA, and additional comorbidities were examined. Odds ratios (OR) were calculated with 95% confidence intervals (CI). Results We found that PoRCs appeared more frequently in moderate (p = 0.048, OR: 1.79, CI [1.004, 3.194]) and severe OSA (p = 0.002, OR: 4.06, CI [1.68, 9.81]) compared to non‐OSA patients. No significant difference was detected in the appearance of major complications (p = 0.200, OR: 2.14, CI [0.67, 6.86]) comparing OSA and non‐OSA populations. No significant difference was observed in comorbidities (p = 0.669, OR: 1.29, CI [0.40, 4.14]) or in the distribution of PoRCs (p = 0.904, OR: 0.94, CI [0.36, 2.45]) between the two groups. Conclusion Uniform guidelines and a revision of postoperative monitoring are called for as children with moderate and severe OSA are more likely to develop PoRCs following AT surgery based on our results, but no significant difference was found in mild OSA. Furthermore, the presence of OSA alone is not associated with an increased risk of developing major complications.

show abstract

Stellungnahme zur Altersuntergrenze bei der ambulanten Durchführung von Adenotomien und Tonsillotomien

Deitmer,

Beck,

Becke-Jakob

et al. 2023

Laryngorhinootologie

View full text Add to dashboard Cite

ZusammenfassungMit Beginn des Jahres 2023 haben sich in der Regelung für das ambulante Operieren in Deutschland erhebliche Änderungen ergeben, die in einem trilateralen Vertrag der Selbstverwaltung zwischen dem Spitzenverband der gesetzlichen Krankenversicherungen, der Deutschen Krankenhausgesellschaft und der Kassenärztlichen Bundesvereinigung niedergelegt wurden. Hier wurden unter anderem in einem Katalog Tatbestände angegeben, unter denen eine Operation nicht oder nur fraglich ambulant durchgeführt werden sollte. In diesem Katalog wurde zum Patientenalter ausgeführt: „Bis zur Vollendung des ersten Lebensjahres kann eine stationäre Durchführung einer Leistung begründet sein.“ Diese Formulierung für sich bedeutet, dass Kinder ab einem Jahr regelhaft ambulant zu operieren sind.In den wissenschaftlichen Fachgesellschaften für HNO-Heilkunde, Kopf und Halschirurgie sowie für Anästhesiologie und Intensivmedizin regten sich Zweifel, ob diese Altersgrenze auch für Operationen im Rachen wie Adenotomie oder Tonsillotomie wissenschaftlich begründbar sei.Es wurde eine Recherche in internationalen Leitlinien sowie in der internationalen Literatur durchgeführt und die dortigen Aussagen bewertet. Die Ergebnisse dieser Literaturrecherche wurden mit Vertretern der Arbeitsgemeinschaft Pädiatrische HNO-Heilkunde (AG PädHNO), der Deutschen Gesellschaft für HNO-Heilkunde, Kopf- und Hals-Chirurgie (DGHNO-KHC) und dem wissenschaftlichen Arbeitskreis Kinderanästhesie (WAKKA) der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI) in Konferenzen beraten.Diese Konsensfindung ergab, dass eine strikte Altersgrenze mit dem vollendeten ersten Lebensjahr für die ambulante Durchführung von Adenotomien und Tonsillotomien nicht sachgerecht ist. Zunächst ist überhaupt die Angabe einer strikten Altersgrenze fragwürdig, da unabhängig vom Alter etliche andere medizinische und soziale Faktoren Einfluss auf die verantwortungsvolle Durchführbarkeit ambulanter Operationen haben. Im Weiteren ist die Altersgrenze von einem Jahr mit Blick auf Literatur, Leitlinien und praktische Ausübung im internationalen Bereich nicht als sachgerecht anzusehen. Die Bewertung der Literatur und die Beachtung der Durchführung im internationalen Bereich lassen eine Altersgrenze eher in dem Bereich von 2–3 Jahren als sachgerecht erscheinen.Diese Übersichtsarbeit gibt den verantwortlichen Ärzten vielerlei Erkenntnisse, Aspekte und Argumente an die Hand, um die Entscheidung zur ambulanten oder stationären Durchführung dieser Operationen sachgerecht und verantwortungsvoll treffen zu können.

show abstract

Adenoidectomy: Inpatient criteria study

Cited by 4 publications

References 8 publications

A National Analysis of Inpatient Pediatric Adenoidectomy

A National Analysis of Inpatient Pediatric Adenoidectomy

The risk of postoperative respiratory complications following adenotonsillar surgery in children with or without obstructive sleep apnea: A systematic review and meta‐analysis

Stellungnahme zur Altersuntergrenze bei der ambulanten Durchführung von Adenotomien und Tonsillotomien

Contact Info

Product

Resources

About