Adenotonsillectomy Complications: A Meta-analysis

Abstract

BACKGROUND AND OBJECTIVE: Complications after adenotonsillectomy (AT) in children have been extensively studied, but differences between children with and without obstructive sleep apnea (OSA) have not been systematically reported. Our objective was to identify the most frequent complications after AT, and evaluate if differences between children with and without OSA exist.METHODS: Several electronic databases were searched. A partial gray literature search was undertaken by using Google Scholar. Experts were consulted to identify any missing publications. Studies assessing complications after AT in otherwise healthy children were included. One author collected the required information from the selected articles. A second author crosschecked the collected information and confirmed its accuracy. Most of the selected studies collected information from medical charts.RESULTS: A total of 1254 studies were initially identified. Only 23 articles remained after a 2-step selection process. The most frequent complication was respiratory compromise (9.4%), followed by secondary hemorrhage (2.6%). Four studies compared postoperative complications in children with and without OSA, and revealed that children with OSA have nearly 5 times more respiratory complications after AT than children without OSA (odds ratio = 4.90; 95% confidence interval: 2.38-10.10). In contrast, children with OSA are less likely to have postoperative bleeding when compared with children without OSA (odds ratio = 0.41; 95% confidence interval: 0.23-0.74). CONCLUSIONS:The most frequent early complications after AT are respiratory compromise and secondary hemorrhage. Based on the current limited evidence, children with OSA appear to have more respiratory complications. Conversely, hemorrhage appears to be more frequent in children without OSA.

Double-Blind Randomized Placebo-Controlled Trial of Single-Dose Intravenous Acetaminophen for Pain Associated With Adenotonsillectomy in Pediatric Patients With Sleep-Disordered Breathing

“…This finding was consistent with previous published data showing a respiratory complication frequency of 9.4% in pediatric adenotonsillectomy patients. 24 Of the 9.2% of our study cohort who had unanticipated respiratory events, 40% also required breakthrough pain medications at some point during their PACU stay. None of these respiratory events were life-threatening and were easily managed by an attending anesthesiologist.…”

Tramadol vs dexmedetomidine for emergence agitation control in pediatric patients undergoing adenotonsillectomy with sevoflurane anesthesia: prospective randomized controlled clinical study

“…Postoperative period following adenotonsillectomy is often challenging and maintaining effective pain control is important to decrease the incidence of the emergence agitation, dehydration, and hemorrhage from healing surgical wounds [1–3]. The choice of analgesic agents influences the occurrence of complications such as postoperative nausea and vomiting (PONV), emergence agitation, and cardiorespiratory complications [4].…”

Clinical Prediction Rules, Adenotonsillectomy and Children With Obstructive Sleep Apnea: What's Next?

“…Studies in children have reported "very" severe OSA (AHI > 20) in isolation as not being predictive of PRCs, suggesting it is some combination of age, ill-defined comorbidities including obesity, ethnicity, and other unknown factors that modulate the risk and predispose the child to complications at a lower AHI threshold. [15][16][17][18][19][20] Obesity was not included in Smith et al's final prediction rule, suggesting in isolation it is a non-risk factor, which has also been supported by recent literature. 20 The degree of nocturnal hypoxemic burden measured as clusters of oxygen desaturation, total sleep time < 90% saturation, or as an oxygen desaturation index are increasingly being adopted to predict the presence and severity of OSA and risk for a PRC following AT.…”