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Published on: November 6, 2019
Predicting complications after adenotonsillectomy in children 3 years old and younger
Michael E McCormick1, Anthony Sheyn, Michael Haupert
1Department of Otolaryngology-Head & Neck Surgery, Wayne State University School of Medicine, Detroit, MI, United States. Michaelemccormick@gmail.com
Insights
Young children undergoing adenotonsillectomy face early complications, with younger age, nasal obstruction, reflux, prematurity, and heart issues being key risk factors. Close monitoring is advised for these vulnerable pediatric patients.
Area of Science:
- Pediatric Otolaryngology
- Surgical Safety
- Pediatric Anesthesiology
Background:
- Adenotonsillectomy is a common pediatric surgical procedure.
- Early post-operative complications can significantly impact patient recovery and hospital resource utilization.
- Identifying risk factors in young children (<4 years old) is crucial for targeted management.
Purpose of the Study:
- To determine the risk factors associated with early complications within 24 hours after adenotonsillectomy in young children (<4 years old).
Main Methods:
- Retrospective chart review of pediatric patients aged 3 years and younger undergoing adenotonsillectomy.
- Analysis of complications occurring on post-operative days 0-1, including total and airway-related events.
- Statistical identification of significant predictors for early post-operative complications.
Main Results:
- A total of 993 young patients were included, with a mean age of 2.94 years.
- Overall complication rate was 9.9%, with 3.5% occurring on post-operative days 0-1.
- Predictors for early complications included nasal obstruction, gastroesophageal reflux disease, prematurity, and cardiovascular anomalies. Younger age (1-2 years), larger adenoid size, nasal obstruction, and cardiovascular anomalies predicted airway complications.
Conclusions:
- Children aged 1-2 years with nasal obstruction, large adenoids, GERD, prematurity, or cardiovascular anomalies are at higher risk for early post-operative complications after adenotonsillectomy.
- Early identification of these risk factors allows for closer monitoring and tailored perioperative care in this vulnerable pediatric population.
- This study provides valuable insights for optimizing surgical outcomes in young children undergoing adenotonsillectomy.
Objectives:
To identify risk factors for complications in the first 24h after surgery in the young (<4 years old) adenotonsillectomy patient.
Methods:
A retrospective chart review was performed at a tertiary care children's hospital. Consecutive records of all children of age 3 years and younger undergoing adenotonsillectomy over a 5 year period were included in the study. The main outcomes measured were total and airway complications occurring on post-operative days 0-1.
Results:
993 patients were included in the study. The mean age was 2.94 years old. Witnessed apneas (74.1%) and snoring (59.2%) were the most frequent pre-operative symptoms. 700 children were admitted with a mean length-of-stay of 1.22 days (0-9 days) and a mean time-to-oral intake of 0.28 days (0-4 days) among those patients admitted. The total number of complications was 102 in 98 patients (9.9%). There were 35 complications on post-operative days (POD) 0-1 (3.5%), and 23 of those were airway-related (2.3%). With regard to all complications on POD 0-1, significant predictors were nasal obstruction, gastroesophageal reflux disease, prematurity and a history of cardiovascular anomalies. Significant predictors of airway complications on POD 0-1 were younger age (1-2 years old), larger adenoid size, nasal obstruction, and a history of cardiovascular anomalies.
Conclusions:
Knowing the stated risk factors for complications in the early post-operative period after adenotonsillectomy in the younger pediatric patient can help select certain patients for closer monitoring. Specifically, children aged 1-2 years old with a history of nasal obstruction from large adenoids, gastroesophageal reflux disease, prematurity, and/or cardiovascular anomalies appear to be at higher risk for early complications and should warrant closer observation.
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