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Published on: December 6, 2016
Complications of adenotonsillectomy for obstructive sleep apnea in school-aged children
Sofia Konstantinopoulou1, Paul Gallagher2, Lisa Elden3
1Department of Pediatrics, Sleep Center, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States.
Insights
Post-adenotonsillectomy complications are rare in healthy school-aged children with obstructive sleep apnea. Polysomnographic and demographic factors did not predict complications in this study population.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Pediatric Surgery
Background:
- Adenotonsillectomy is a common treatment for pediatric obstructive sleep apnea syndrome.
- Post-operative complications can occur, necessitating careful patient selection for hospitalization.
- Identifying children at risk for complications is crucial for optimizing post-operative care.
Purpose of the Study:
- To investigate the predictive value of polysomnographic parameters for post-operative complications in children undergoing adenotonsillectomy.
- To assess the incidence of complications in a cohort of otherwise healthy school-aged children with obstructive sleep apnea.
Main Methods:
- Children aged 5-9 years with obstructive sleep apnea (OSA) underwent adenotonsillectomy as part of the Childhood AdenoTonsillectomy (CHAT) study.
- Demographic variables and polysomnographic data were collected and analyzed for associations with surgical complications.
- Statistical tests including Chi-square, Fisher's exact, and Mann-Whitney tests were employed.
Main Results:
- Of 221 children, 7% experienced complications, with non-respiratory complications (dehydration, hemorrhage, fever) being more common than respiratory ones.
- No statistically significant associations were found between demographic factors (gender, race, obesity) and post-operative complications.
- Key polysomnographic parameters, including apnea-hypopnea index and oxygen saturation levels, did not predict complications.
Conclusions:
- The risk of post-adenotonsillectomy complications is low in healthy school-aged children with obstructive sleep apnea.
- Current polysomnographic and demographic parameters were not predictive of complications in this specific pediatric cohort.
- Further research is needed to identify specific patient subgroups at higher risk for adverse post-operative outcomes.
Introduction:
Adenotonsillectomy is the treatment of choice for most children with obstructive sleep apnea syndrome, but can lead to complications. Current guidelines recommend that high-risk children be hospitalized after adenotonsillectomy, but it is unclear which otherwise-healthy children will develop post-operative complications. We hypothesized that polysomnographic parameters would predict post-operative complications in children who participated in the Childhood AdenoTonsillectomy (CHAT) study.
Methods:
Children in the CHAT study aged 5-9 years with apnea hypopnea index 2-30/h or obstructive apnea index 1-20/h without comorbidities other than obesity/asthma underwent adenotonsillectomy. Associations between demographic variables and surgical complications were examined with Chi square and Fisher's exact tests. Polysomnographic parameters between subjects with/without complications were compared using Mann-Whitney tests.
Results:
Of the 221 children (median apnea hypopnea index 4.7/h, range 1.2-27.7/h; 31% obese), 16 (7%) children experienced complications. 3 (1.4%) children had respiratory complications including pulmonary edema, hypoxemia and bronchospasm. Thirteen (5.9%) had non-respiratory complications, including dehydration (4.5%), hemorrhage (2.3%) and fever (0.5%). There were no statistically significant associations between demographic parameters (gender, race, and obesity) or polysomnographic parameters (apnea hypopnea index, % total sleep time with SpO2<92%, SpO2 nadir, % sleep time with end-tidal CO2>50Torr) and complications.
Conclusions:
This study showed a low risk of post-adenotonsillectomy complications in school-aged healthy children with obstructive apnea although many children met published criteria for admission due to obesity, or polysomnographic severity. In this specific population, none of the polysomnographic or demographic parameters predicted post-operative complications. Further research could identify the patients at greatest risk of post-operative complications.
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