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Published on: November 6, 2019
Complications of adenotonsillectomy in patients younger than 3 years
Dennis J Spencer1, Jacqueline E Jones
1Weill Cornell Medical College, New York, New York, USA.
Insights
Adenotonsillectomy in children under 3 has a low complication rate, suggesting current inpatient admission guidelines may need reevaluation. Postoperative care should consider individual patient and family factors, not just age.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Anesthesiology
Background:
- Adenotonsillectomy is a common procedure in children.
- Current guidelines often mandate inpatient admission for children under 3 years undergoing this surgery.
- The necessity of mandatory admission for this age group requires further investigation.
Purpose of the Study:
- To evaluate the complication rate of adenotonsillectomy in children younger than 3 years without severe obstructive sleep apnea.
- To assess the appropriateness of mandatory postoperative inpatient admission for this demographic.
Main Methods:
- Retrospective medical record review of 86 children under 3 years who underwent adenotonsillectomy.
- Data collected included patient demographics, surgical indications, interventions, and postoperative complications.
- Complications such as bleeding, dehydration requiring admission, and airway intervention were recorded.
Main Results:
- 93% of patients experienced no intraoperative or postoperative complications.
- Dehydration was the most common complication, leading to 4.7% of readmissions.
- No airway complications were observed; other minor complications were managed with same-day discharge.
Conclusions:
- Adenotonsillectomy in otherwise healthy children under 3 years has a low complication rate.
- Mandatory inpatient admission criteria for this age group should be re-evaluated.
- Admission decisions should incorporate clinical assessment and family support resources.
Objective:
To evaluate the complication rate for adenotonsillectomy in children younger than 3 years, without a diagnosis of severe obstructive sleep apnea, to assess the necessity for postoperative inpatient admission.
Design:
Retrospective medical record review (January 1, 2003, through October 31, 2009).
Setting:
Tertiary care academic medical center.
Patients:
Retrospective medical record review of 105 patients younger than 3 years who underwent adenotonsillectomy performed by a single surgeon. Nineteen patients were excluded from our review because of incomplete medical records or severe underlying disease, leaving a total of 86 patients with medical records available for inclusion in our study. Patient medical records were deidentified and reviewed for age, sex, indications for surgery, intraoperative and perioperative interventions, and postoperative complications. One child with a diagnosis of severe obstructive sleep apnea was excluded from the study.
Main Outcome Measures:
Complications, including bleeding, dehydration requiring admission, and airway intervention, during the intraoperative or perioperative period were recorded.
Results:
The mean age of the study population was approximately 27.5 months (range, 13-35 months), with most children (76.5%) between 23 and 31 months of age. Among the patients whose records were reviewed, 80 (93.0%) did not experience any intraoperative or postoperative complications. Dehydration was the most common complication and was the cause of all documented readmissions (4.7%) in our patients who ranged in age from 14 to 30 months. Two patients had other complications, reactive airway disease (n=1) and postoperative fever (n=1), which were identified and treated in the postanesthesia care unit, resulting in same-day discharge. No airway complications were noted in our study.
Conclusions:
Our study reveals a low complication rate in children younger than 3 years. The recommendations for mandatory admission for children younger than 3 years should be reexamined. Criteria for inpatient admission for children younger than 3 years should be based on preoperative and postoperative clinical evaluation of the patient and an evaluation of the family resources for adequately caring for young children at home in the postoperative period. These recommendations apply only to otherwise healthy children (American Society of Anesthesiologists classifications I and II) without a diagnosis of severe obstructive sleep apnea syndrome.
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