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Risk factors for respiratory complications after adenotonsillectomy in children with obstructive sleep apnea
Renato Oliveira Martins1, Nuria Castello-Branco2, Jefferson Luis de Barros3
1School of Medicine, São Paulo State University Botucatu, Botucatu, Brazil.
Insights
Children with obstructive sleep apnea (OSA) undergoing adenotonsillectomy face respiratory risks. High apnea-hypopnea index (AHI), oxygen desaturation index (ODI), low SpO2, and rhinitis predict complications.
Area of Science:
- Pediatric Surgery
- Sleep Medicine
- Critical Care Medicine
Background:
- Adenotonsillectomy is a common procedure for pediatric obstructive sleep apnea (OSA).
- Respiratory complications post-adenotonsillectomy can necessitate pediatric intensive care unit (PICU) admission.
- Identifying risk factors is crucial for optimizing patient management and outcomes.
Purpose of the Study:
- To determine predictors of respiratory complications in children with OSA after adenotonsillectomy.
- To identify specific patient characteristics associated with PICU referral following the procedure.
Main Methods:
- A historical cohort study included 53 children referred to the PICU after adenotonsillectomy.
- Statistical analyses, including Student's t-test, Mann-Whitney test, and chi-square test, were employed.
- Risk factors for respiratory complications were analyzed.
Main Results:
- Twenty-one children (39.6% of referred) experienced respiratory complications.
- Independent predictors identified were high apnea-hypopnea index (AHI), high oxygen desaturation index (ODI), low SpO2 nadir, prolonged intubation, and rhinitis.
- Complications ranged from minor oxygen desaturation to severe events like laryngospasm and pneumonia.
Conclusions:
- Children with OSA undergoing adenotonsillectomy are at risk for respiratory complications.
- High AHI, high ODI, low SpO2 nadir, and rhinitis are significant risk factors.
- These findings aid in risk stratification and perioperative care planning.
Objective:
To identify risk factors for respiratory complications after adenotonsillectomy in children ≤ 12 years of age with obstructive sleep apnea who were referred to the pediatric ICU (PICU).
Methods:
A cross-sectional historical cohort study analyzing 53 children after adenotonsillectomy who met predetermined criteria for PICU referral in a tertiary level teaching hospital. The Student's t-test, Mann-Whitney test, and chi-square test were used to identify risk factors.
Results:
Of the 805 children undergoing adenotonsillectomy between January of 2006 and December of 2012 in the teaching hospital, 53 were referred to the PICU. Twenty-one children (2.6% of all those undergoing adenotonsillectomy and 39.6% of those who were referred to the PICU) had respiratory complications. Of those 21, 12 were male. The mean age was 5.3 ± 2.6 years. A high apnea-hypopnea index (AHI; p = 0.0269), a high oxygen desaturation index (ODI; p = 0.0082), a low SpO2 nadir (p = 0.0055), prolonged orotracheal intubation (p = 0.0011), and rhinitis (p = 0.0426) were found to be independent predictors of respiratory complications. Some of the complications observed were minor (SpO2 90-80%), whereas others were major (SpO2 ≤ 80%, laryngospasm, bronchospasm, acute pulmonary edema, pneumonia, and apnea).
Conclusions:
Among children up to 12 years of age with OSA, those who have a high AHI, a high ODI, a low SpO2 nadir, or rhinitis are more likely to develop respiratory complications after adenotonsillectomy than are those without such characteristics.
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