Ambulatory tonsillectomy for children with severe obstructive sleep apnea without risk factors

Kong, Derek Kai; Kong, Amanda M.; Wasserman, Isaac; Villavisanis, Dillan F.; Hackett, Alyssa M.

doi:10.1016/j.amjoto.2020.102467

Cited by 7 publications

(15 citation statements)

References 18 publications

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“…2,4,[8][9][10][11][12][13][14][15][16][17][18][19][20] See Figure 1 for a PRISMA flow diagram illustrating the study selection process. 2,4,[8][9][10][11][12][13][14][15][16][17][18][19][20] All included studies were observational: 14 retrospective and one prospective. 12 One study had a control group for outcome comparison.…”

Section: Resultsmentioning

confidence: 99%

“…15,16,18 Marrugo Pardo et al 4 included a majority (86%) of patients with severe OSA on PSG. Kong et al 8 classified 92.6% of their study population as clinically severe, with an additional 6% found to be severe on PSG.…”

Section: Ascertainment Of Osamentioning

confidence: 95%

“…9,13,14,17,18 Three studies diagnosed OSA by using typical clinical symptoms, 10,19,20 and in another three studies the clinical diagnosis was confirmed by sleep studies or polysomnography (PSG) in some of the patients. 8,12,15 Four studies only included PSG-confirmed cases. 2,4,11,16 The severity of OSA was not stated in the majority of studies.…”

Section: Ascertainment Of Osamentioning

confidence: 99%

“…Seven studies reported their day-case discharge criteria in children with OSA following surgery 8,9,15,[17][18][19][20] (Table 1). No standardised day-case discharge criteria was used across studies, however, common themes were: age over 2 years, mild-to-moderate OSA, no significant comorbidities, living with a reliable caregiver in close proximity to the hospital and absence of post-operative complications in the first few hours of observation.…”

Section: Criteria For Same-day Dischargementioning

confidence: 99%

“…showing the process of inclusion and exclusion children). 2,8,9,[13][14][15]17,19,20 Of these, seven studies commented on the proportion planned day-case surgeries that were successful, which ranged from 92.9% to 100% (n = 2446). 2,8,9,13,15,19,20 The overall proportion of successful day-case surgeries in the planned day-case groups was 96.1%.…”

Section: Criteria For Same-day Dischargementioning

confidence: 99%

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Day‐case discharge criteria and safety of children undergoing adenoidectomy and tonsillectomy for obstructive symptoms—A systematic review

Gowda

Leong

Edafe

2022

Clinical Otolaryngology

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Objectives Obstructive sleep apnoea (OSA) is a common indication for adenoidectomy and tonsillectomy in children. Traditional practice involves overnight admission to monitor for respiratory complications. However, there is a shift towards same‐day discharge in selected patients. This systematic review aims to critically evaluate day‐case criteria and safety in children with OSA undergoing adenotonsillectomy. Design We performed a systematic search of EMBASE, Medline and the Cochrane library. All data collected were independently validated for accuracy. Quality assessment of included articles was performed. The protocol was registered with PROSPERO. Results A total of 15 studies were included (10 731 patients). There was heterogeneity in methods used to ascertain OSA, day‐case discharge criteria and lack of prospective discharge protocol. The proportion of children considered for planned day‐case surgery ranged from 28.7%–100% based on individual criteria, with an average rate of successful same‐day discharge of 96.1% in these patients. The reported rates of post‐operative respiratory adverse events and need for airway intervention were 0%–27.3% and 0.4%–6.8%, respectively. There was no reported mortality. The studies were considered low to medium on quality assessment. Conclusion There is a lack of prospective data on day‐case criteria and systematic assessment of post‐operative complications in children with OSA undergoing adenoidectomy and tonsillectomy. However, current literature suggests that day‐case surgery is safe in carefully selected patients. Better characterisation of patient‐specific risk factors is needed to develop an optimal criteria‐based timeline for safe discharge. This has the potential to improve confidence and uptake across units.

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Section: Resultsmentioning

confidence: 99%

Section: Ascertainment Of Osamentioning

confidence: 95%

Section: Ascertainment Of Osamentioning

confidence: 99%

Section: Criteria For Same-day Dischargementioning

confidence: 99%

Section: Criteria For Same-day Dischargementioning

confidence: 99%

See 3 more Smart Citations

Day‐case discharge criteria and safety of children undergoing adenoidectomy and tonsillectomy for obstructive symptoms—A systematic review

Gowda

Leong

Edafe

2022

Clinical Otolaryngology

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Pediatric Postoperative Outcomes for Severe and Very Severe Obstructive Sleep Apnea Syndrome

Hurly,

Clements,

Ryan

et al. 2024

The Laryngoscope

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ObjectiveTo determine if increasing obstructive sleep apnea syndrome (OSAS) severity, as determined by preoperative polysomnography data, is an independent risk for respiratory complications and level of follow‐up care after adenotonsillectomy or tonsillectomy.MethodsA retrospective analysis of patients ≤21 years of age with severe OSAS (obstructive apnea–hypopnea index [OAHI] >10) undergoing adenotonsillectomy or tonsillectomy. Patients were categorized based on preoperative polysomnography data (PSG). Outcome measures including respiratory complications were collected via chart review. Logistic regression was used in the analysis of all parameters, and Wilcoxon Rank Sum tests were used for analysis of both OAHI and oxygen saturation nadir as continuous variables. All surgeries were performed at Johns Hopkins Hospital, a tertiary care center.ResultsWe identified 358 patients with severe OSAS who had adenotonsillectomy or tonsillectomy. OAHI >40 and oxygen saturation nadir <80% were significantly associated with postoperative respiratory complications. Increasing OAHI and O2 saturation <80% was each associated with unplanned continuous positive airway pressure (CPAP) initiations postoperatively. There was no association between hypercarbia and presence of any complications.ConclusionPatients with very severe OSAS (preoperative OAHI ≥40) as determined by preoperative PSG may be at higher risk of developing respiratory complications postoperatively. However, there does not appear to be a linear association with increasing severity of OAHI on regression analysis. Further research is needed to understand factors associated with complications in severe and very severe OAHI.Level of Evidence4 Laryngoscope, 2024

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Early Adverse Respiratory Outcomes in Obese Pediatric Tonsillectomy Patients

Wie,

Zaccor,

Zou

et al. 2024

Otolaryngol.--head neck surg.

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ObjectiveTo determine if body mass index (BMI) is predictive of adverse respiratory events (ARE) in the obese pediatric population undergoing tonsillectomy.Study DesignCase series with chart review.SettingSingle institution academic otolaryngology practice.MethodsAll patients 3 to 12 years old with BMI ≥95th percentile that underwent tonsillectomy March 1, 2011 to July 15, 2020 were included. The study excluded patients with comorbidities that warranted admission independent of BMI, including Trisomy 21, gross developmental delay, neuromuscular disorders, and congenital heart disease. Perioperative AREs following tonsillectomy were recorded. AREs were defined as postoperative desaturation (SpO2 < 90%), intubation, continuous positive airway pressure (CPAP), or new O2 requirement for >2 hours.ResultsEighteen patients (8%) had at least 1 ARE. There were no children age 5 and older with a BMI 95th percentile to 98.9th percentile who had an early adverse respiratory outcome. Preoperative polysomnogram (PSG) metrics, obstructive apnea‐hypopnea index (oAHI), and oxygen saturations (SpO2) nadir was significantly different between patients with and without AREs (mean oAHI 54.3 vs 17.4, P = .02; mean SpO2 nadir 73.1% vs 84.5%, P = .05). There was no significant difference in the BMI z score (2.88 vs 2.45, P = .09) between groups.ConclusionAREs requiring inpatient management are uncommon in obese children after tonsillectomy. BMI is a poor independent indication for admission except at BMI extremes. We found significantly higher oAHI and lower SpO2 nadir on PSG indicate a higher risk for AREs and can guide admission postoperatively. There may be a subset of obese tonsillectomy patients who can be safely discharged home on the day of surgery.

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Ambulatory tonsillectomy for children with severe obstructive sleep apnea without risk factors

Cited by 7 publications

References 18 publications

Day‐case discharge criteria and safety of children undergoing adenoidectomy and tonsillectomy for obstructive symptoms—A systematic review

Day‐case discharge criteria and safety of children undergoing adenoidectomy and tonsillectomy for obstructive symptoms—A systematic review

Pediatric Postoperative Outcomes for Severe and Very Severe Obstructive Sleep Apnea Syndrome

Early Adverse Respiratory Outcomes in Obese Pediatric Tonsillectomy Patients

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