Predicting respiratory complications in paediatric adenotonsillectomy: a risk stratification protocol

Chia, Clemente; Haran, Shankar; Wong, Tracey; Lam, K; Nixon, Gillian M.; Paul, Eldho; Paddle, Paul

doi:10.21037/ajo-19-75

Cited by 3 publications

(17 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This may be attributable to the strict patient selection criteria and judicial use of pre‐operative respiratory investigations to select a patient cohort less likely to experience major respiratory complications. A similar triage tool used in selecting T&A patients to undergo surgery at lower‐acuity settings utilizing pre‐operative oximetry reports a minor complication rate of 1.2% ( n = 11/904), and a major complication rate of 0% ( n = 0/904) 19 . Given the similar pre‐operative selection criteria and triage methods, this highlights the utility of pre‐operative respiratory investigations.…”

Section: Discussionmentioning

confidence: 75%

“…A similar triage tool used in selecting T&A patients to undergo surgery at lower-acuity settings utilizing pre-operative oximetry reports a minor complication rate of 1.2% (n = 11/904), and a major complication rate of 0% (n = 0/904). 19 Given the similar pre-operative selection criteria and triage methods, this highlights the utility of pre-operative respiratory investigations.…”

Section: Discussionmentioning

confidence: 96%

“…[14][15][16] In patients with OSA, the incidence of respiratory complications is 10.0% to 20.0%, and the risk increases with severity, as diagnosed by polysomnography (PSG), 3,17 or quantified via McGill Oximetry Score on overnight oximetry. 18 Major tertiary hospitals in Australia 19 and New Zealand 20 have developed perioperative triaging protocols to determine care locations, mitigating tonsillectomy risks.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Paediatric tonsillectomy and adenotonsillectomy in a rural setting: a retrospective study over a period of 6‐years

Key

Alnimri

Ney

et al. 2022

ANZ Journal of Surgery

Self Cite

View full text Add to dashboard Cite

Background: Swan Hill District Health (SHDH) provides Otolaryngological services to outer regional Victoria. A preoperative checklist determines eligibility for tonsillectomy, and the role of preoperative investigations such as oximetry. Visiting specialists who provide T&A also remain on-site for 24 h post-surgery. Management of post-discharge complications is supported by SHDH's Emergency Department. Unstable patients are transferred to tertiary care hospitals. This study examines the safety outcomes associated with rural Tonsillectomy and adenotonsillectomy (T&A) and the impact of peri-operative protocols on these outcomes. Methods: This is a retrospective cohort study of all paediatric (2-18 years old) patients undergoing T&A from August 2014 to June 2020 at SHDH. Four external hospital databases which accept patient transfers from SHDH were searched for T&A-related complications. The primary outcome was complication incidence. Secondary outcomes were length of stay, and rates of hospital readmissions, return to theatre and inter-hospital transfer. Results: Two hundred and four patients were included, with median age 6 years old; 68.1% (n = 139/204) had obstructive sleep apnoea, or sleep disordered breathing, wherein 36.0% (n = 50/139) had documented evidence of normal/inconclusive oximetry. The complication rate is 6.9% (n = 14/204), with two intraoperative, five perioperative and seven post-discharge complications. All intra-and peri-operative complications were managed locally. All post-discharge complications presented to outer regional EDs. Two patients required inter-hospital transfer for monitoring of post-tonsillectomy bleeds in a specialist unit. Conclusions: Patients who pass a preoperative risk checklist can safely undergo T&A in selected rural settings which adhere to strict patient selection criteria and implement safety measures to address complications.

show abstract

Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Paediatric tonsillectomy and adenotonsillectomy in a rural setting: a retrospective study over a period of 6‐years

Key

Alnimri

Ney

et al. 2022

ANZ Journal of Surgery

Self Cite

View full text Add to dashboard Cite

show abstract

“…The effectiveness of pre-operative investigations in a peri-operative risk stratification protocol for paediatric patients undergoing elective AT for OSA/SDB, based on a retrospective cohort study from 2011 to 2017, has previously been published. 10 All patients underwent either pre-operative oximetry, PSG, or both. Subgroup analysis demonstrated similar odds ratio in predicting post-operative respiratory complications in severe OSA.…”

Section: Target Population and Subgroupsmentioning

confidence: 99%

“…7 The McGill Oximetry Score (MOS), a visual method for quantifying desaturation events on overnight oximetry, has a positive predictive value of 97% for OSA, 5,8,9 and demonstrated similar efficacy to PSG in a previously reported perioperative risk stratification protocol in triaging patients to an appropriate care location based upon predicting post-operative respiratory complications. 5,9,10 Elective AT represents 2.45% of all Australian elective surgeries, 11 and 7.24% of paediatric hospitalisations. 12 Australia's healthcare is funded nationally, 13 and reimbursement for each inpatient admission is publicly available.…”

Section: Introductionmentioning

confidence: 99%

Cost‐minimisation analysis of polysomnography and pulse oximetry in a risk stratification protocol for paediatric adenotonsillectomy

Key

Chia

Nixon

et al. 2022

ANZ Journal of Surgery

Self Cite

View full text Add to dashboard Cite

Background: Severe obstructive sleep apnoea (OSA) is associated with increased risk of respiratory compromise in the post-operative period following adenotonsillectomy (AT). This study analyses the economic cost of polysomnography or overnight oximetry as part of pre-operative risk stratification in paediatric AT, supplementing previously published research demonstrating the efficacy of this protocol in predicting respiratory complications. Methods: This cost-minimisation analysis examines costs associated with pre-operative overnight oximetry and polysomnography in triaging paediatric patients older than 2 years old, with no major comorbidities except for OSA, undergoing AT for OSA (n = 1801) to either a secondary or quaternary Australian hospital. Decision analysis modelling via probability trees were utilized to estimate pre-and peri-operative costs. A third hypothetical 'no investigation' model based upon conducting all AT at a secondary hospital was performed. Costs are derived from the financial year 2020-2021, censored at discharge. Results: The total cost per patient of AT including pre-operative investigations of oximetry and polysomnography, and associated inpatient costs, were AUD4181.34 and 5013.99 respectively. This is more expensive compared to a hypothetical no-investigation model (AUD3958.98). Conclusion: Within the scope of this partial economic evaluation, this study finds a small additional cost for a model of care involving overnight oximetry as a pre-operative triage tool, balanced by the reduced cost of care in a lower acuity centre for low-risk patients and potential high cost of complications if all children are treated in a low acuity centre. This supports oximetry in peri-operative risk stratification for paediatric AT from a financial perspective.

show abstract

Demonstration of Accuracy and Feasibility of Remotely Delivered Oximetry: A Blinded, Controlled, Real-World Study of Regional/Rural Children with Obstructive Sleep Apnoea

et al. 2023

View full text Add to dashboard Cite

Objectives: Evaluate diagnostic accuracy and feasibility of a mail-out home oximetry kit. Design: Patients were referred for both the tertiary/quaternary-centre hospital-delivered oximetry (HDO) and for the mail-out remotely-delivered oximetry (RDO). Quantitative and qualitative data were collected. The COVID-19 pandemic began during this study; therefore, necessary methodological adjustments were implemented. Setting: Patients were first evaluated in Swan Hill, Victoria. RDO kits were sent to home addresses. For the HDO, patients travelled to the Melbourne city area, received the kit, stayed overnight, and returned the kit the following morning. Participants: All consecutive paediatric patients (aged 2–18), diagnosed by a specialist in Swan Hill with obstructive sleep apnoea (OSA) on history/examination, and booked for tonsillectomy +/− adenoidectomy, were recruited. Main outcome measures: Diagnostic accuracy (i.e., comparison of RDO to HDO results) and test delivery time (i.e., days from consent signature to oximetry delivery) were recorded. Patient travel distances for HDO collection were calculated using home/delivery address postcodes and Google® Maps data. Qualitative data were collected with two digital follow-up surveys. Results: All 32 patients that had both the HDO and RDO had identical oximetry results. The HDO mean delivery time was 87.7 days, while the RDO mean delivery time was 23.6 days (p value: <0.001). Qualitatively, 3/28 preferred the HDO, while 25/28 preferred the RDO (n = 28). Conclusions: The remote option is as accurate as the hospital option, strongly preferred by patients, more rapidly completed, and also an ideal investigation delivery method during certain emergencies, such as the COVID-19 pandemic.

show abstract

Predicting respiratory complications in paediatric adenotonsillectomy: a risk stratification protocol

Cited by 3 publications

References 24 publications

Paediatric tonsillectomy and adenotonsillectomy in a rural setting: a retrospective study over a period of 6‐years

Paediatric tonsillectomy and adenotonsillectomy in a rural setting: a retrospective study over a period of 6‐years

Cost‐minimisation analysis of polysomnography and pulse oximetry in a risk stratification protocol for paediatric adenotonsillectomy

Demonstration of Accuracy and Feasibility of Remotely Delivered Oximetry: A Blinded, Controlled, Real-World Study of Regional/Rural Children with Obstructive Sleep Apnoea

Contact Info

Product

Resources

About