Related Experiment Video
Updated: Mar 5, 2026
Employing the Forced Oscillation Technique for the Assessment of Respiratory Mechanics in Adults
Published on: February 9, 2022
Red cell distribution width as a novel predictor of postoperative respiratory adverse events after adenotonsillectomy
Betul Kozanhan1, Mehmet S Iyisoy2
1Department of Anesthesiology and Reanimation, Education and Research Hospital, Konya, Turkey.
Insights
Elevated red cell distribution width (RDW) before surgery may predict respiratory complications in children with sleep-disordered breathing undergoing adenotonsillectomy. This finding can help identify high-risk patients for better care.
Area of Science:
- Pediatric Anesthesiology
- Sleep Medicine
- Hematology
Background:
- Respiratory adverse events are common after adenotonsillectomy in children with sleep-disordered breathing (SDB).
- Preoperative prediction of these events is crucial for patient care and resource management.
- Red cell distribution width (RDW), a measure of erythrocyte size variability, is linked to adverse outcomes and obstructive sleep apnea severity.
Purpose of the Study:
- To evaluate if elevated RDW is associated with postoperative respiratory adverse events in children with SDB symptoms.
- To determine RDW's predictive value for respiratory complications post-adenotonsillectomy.
Main Methods:
- Prospective, observational, assessor-blinded study of 287 children undergoing adenotonsillectomy for SDB.
- Data collected on adverse events during emergence and in the postanesthesia care unit (PACU).
- RDW levels measured preoperatively.
Main Results:
- Respiratory complications occurred in 22.30% during emergence and 20.14% in PACU.
- Mean RDW was significantly higher in patients with complications (14.36 ± 1.06) versus those without (13.53 ± 0.59).
- RDW showed an adjusted odds ratio of 7.28 for predicting complications, with an AUC of 0.74. A cutoff of 14.7 was identified.
Conclusions:
- Preoperative elevated RDW is associated with an increased risk of respiratory adverse events in children undergoing adenotonsillectomy for SDB.
- RDW may serve as a useful biomarker for predicting postoperative respiratory complications.
- Identifying high-risk patients preoperatively can guide clinical management and preventive strategies.
Background:
Respiratory adverse events are commonly observed after adenotonsillectomy in children with sleep-disordered breathing. Preoperative prediction of these events enhances quality of care and resource management in facilities while encouraging precautions against them. Red cell distribution width, a measure of erythrocyte size variability, has recently been linked to adverse outcomes in a variety of disorders. Red cell distribution width has also been found to be associated with severity of obstructive sleep apnea in adults due to hypoxia-mediated inflammation.
Aim:
The objective of this study was to evaluate whether elevated red cell distribution width is associated with postoperative respiratory adverse events in children with symptoms of sleep-disordered breathing.
Methods:
A prospective, observational, assessor-blinded study was conducted with consecutive children undergoing elective adenotonsillectomy for treatment of sleep-disordered breathing. Under general anesthesia, adenoidectomy was performed by curettage, and tonsillectomy was carried out by dissection. The primary outcome was the occurrence of an adverse event during emergence or in the postanesthesia care unit (PACU).
Results:
Among 287 patients, with mean ± sd age 7.49 ± 3.21, the frequency of respiratory complications during emergence was 62 (22.30%) and in PACU was 56 (20.14%). Mean ± sd red cell distribution width was 14.36 ± 1.06 in patients with complications and higher than that in those without complications 13.53 ± 0.59. Red cell distribution width had an adjusted odds ratio 7.28 (95% CI: 4.30-13.28) and area under the curve value 0.74 (95% CI: 0.67-0.81) to predict postoperative complications. A cutoff value for red cell distribution width was found to be 14.7.
Conclusion:
Our study showed that preoperative elevated red cell distribution width is associated with an increased risk of respiratory adverse events in children undergoing adenotonsillectomy for sleep-disordered breathing.
Related Concept Videos
01:26Endoscopic Studies II: Thoracocentesis
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
01:19Respiratory Assessment: Purpose and Indications
Objectives and Importance:
The primary goal of respiratory assessment is to evaluate patients at early risk of clinical deterioration. Since respiratory distress often precedes other signs of declining health, breathing patterns and sounds become a...
01:29Assessment of Ventilation II: Respiratory Depth and Rhythm
Respiratory depth measures the volume of air inhaled or exhaled during a breath. It can vary from shallow to deep and typically remains consistent when a person is at rest or asleep. Occasionally, individuals will automatically inhale deeply, known as sighing, which inflates the lungs with more air than normal breathing.
To assess respiratory depth, observe the degree of chest excursion or movement:
01:21Acute Respiratory Failure-II
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
01:23Assessment of Respiration
Subjective Assessment: Nurses interview the patient to gather information directly during the subjective assessment. It includes questions about the individual's medical history, medications, and symptoms, focusing on past respiratory conditions like...
01:23Acute Respiratory Failure-IV