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Adenotonsillectomy Complications: A Meta-analysis
Graziela De Luca Canto1, Camila Pachêco-Pereira2, Secil Aydinoz3
1Department of Dentistry, Federal University of Santa Catarina, Florianopolis, Santa Catarina, Brazil; School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Alberta, Canada;
Insights
Children undergoing adenotonsillectomy (AT) face risks like respiratory compromise and bleeding. Obstructive sleep apnea (OSA) increases respiratory issues but lowers bleeding risk post-AT.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Surgical Complications
Background:
- Adenotonsillectomy (AT) is common in children.
- Complications after AT are well-documented, but specific risks for children with obstructive sleep apnea (OSA) are less clear.
- Understanding these differences is crucial for optimizing pediatric surgical care.
Purpose of the Study:
- To identify the most frequent complications following AT in children.
- To compare the incidence of these complications between children with and without OSA.
Main Methods:
- Systematic review of electronic databases and gray literature.
- Inclusion of studies on AT complications in otherwise healthy children.
- Data extraction and cross-checking by two authors.
Main Results:
- Respiratory compromise (9.4%) and secondary hemorrhage (2.6%) were the most common complications.
- Children with OSA had nearly 5 times higher odds of respiratory complications post-AT (OR=4.90).
- Children with OSA had lower odds of postoperative bleeding (OR=0.41).
Conclusions:
- Respiratory compromise and hemorrhage are primary early AT complications.
- Children with OSA face increased respiratory risks but decreased bleeding risks after AT.
- Further research is needed to confirm these findings due to limited evidence.
Background And Objective:
Complications after adenotonsillectomy (AT) in children have been extensively studied, but differences between children with and without obstructive sleep apnea (OSA) have not been systematically reported. Our objective was to identify the most frequent complications after AT, and evaluate if differences between children with and without OSA exist.
Methods:
Several electronic databases were searched. A partial gray literature search was undertaken by using Google Scholar. Experts were consulted to identify any missing publications. Studies assessing complications after AT in otherwise healthy children were included. One author collected the required information from the selected articles. A second author crosschecked the collected information and confirmed its accuracy. Most of the selected studies collected information from medical charts.
Results:
A total of 1254 studies were initially identified. Only 23 articles remained after a 2-step selection process. The most frequent complication was respiratory compromise (9.4%), followed by secondary hemorrhage (2.6%). Four studies compared postoperative complications in children with and without OSA, and revealed that children with OSA have nearly 5 times more respiratory complications after AT than children without OSA (odds ratio = 4.90; 95% confidence interval: 2.38-10.10). In contrast, children with OSA are less likely to have postoperative bleeding when compared with children without OSA (odds ratio = 0.41; 95% confidence interval: 0.23-0.74).
Conclusions:
The most frequent early complications after AT are respiratory compromise and secondary hemorrhage. Based on the current limited evidence, children with OSA appear to have more respiratory complications. Conversely, hemorrhage appears to be more frequent in children without OSA.
