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Predictive factors of early postoperative respiratory complications after tonsillectomy in children with unidentified
Florence Julien-Marsollier1, Pierre Salis1, Rachida Abdat1
1Department of Anaesthesia, Intensive care and Pain Management, Robert Debré University Hospital, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Paris Diderot University (Paris 7), Pres Paris Sorbonne Cité, 75000 Paris, France.
Insights
Children weighing less than 18kg are at higher risk for respiratory complications after tonsillectomy for obstructive sleep apnoea syndrome (OSAS). This finding aids in identifying high-risk pediatric patients undergoing this common procedure.
Area of Science:
- Pediatric Otolaryngology
- Anesthesiology
- Respiratory Medicine
Background:
- Tonsillectomy is a common surgical intervention for pediatric obstructive sleep apnea syndrome (OSAS).
- Postoperative respiratory failure is a significant complication following tonsillectomy, necessitating respiratory support.
Purpose of the Study:
- To identify risk factors for postoperative respiratory complications in children undergoing tonsillectomy.
- To establish predictive markers for respiratory failure post-tonsillectomy in pediatric patients.
Main Methods:
- Retrospective, single-center observational study.
- Inclusion of patients with unanticipated postoperative respiratory failure, excluding those with planned ICU admission.
- Comparison with a control group, analyzing factors including age, weight, surgical indication, and anesthesia duration using univariate and multivariate logistic regression.
Main Results:
- A total of 805 patients underwent adenotonsillectomy; 25 experienced postoperative respiratory failure.
- Statistically significant associations found with age (<4 years), weight (<18kg), OSAS, laryngomalacia, and anesthesia duration.
- Multivariate analysis identified weight <18kg as a key risk factor for postoperative respiratory failure (AUC of ROC: 0.9).
Conclusions:
- Pediatric patients weighing less than 18kg represent a major risk group for postoperative respiratory complications after tonsillectomy.
- This finding can guide preoperative risk assessment and perioperative management strategies for children undergoing tonsillectomy.
Introduction:
Tonsillectomy is considered as a therapeutic option in obstructive sleep apnoea syndrome (OSAS). Postoperative respiratory failure is a complication that can require respiratory support. The main objective of our study is to determine risk factors of postoperative respiratory complications in children undergoing tonsillectomy.
Material And Methods:
This is a retrospective single centre observational study including patients with unanticipated postoperative respiratory failure. Patients with a planned preoperative intensive care admission were excluded (age is lower than 2 years, overweight (>95% percentile of BMI), moderate or severe asthma, major medical conditions). Those patients were compared with randomly selected control patients. Factors studied were: age, weight, indication of surgery, ASA status, preoperative illness conditions, durations of surgery and anaesthesia and administered medications. Statistics used a univariate analysis and a multivariate logistic regression.
Results:
Eight hundred and five patients underwent adenotonsillectomy during the study period and 25 developed postoperative respiratory failure. These patients were compared to 103 non-complicated control patients. Age (<4 years), weight (<18kg), indication of surgery (as SOAS), laryngomalacia, stable and minor congenital cardiac malformation and duration of anaesthesia were found statistically associated. Multivariate analysis found that weight <18kg is a risk factor associated with the occurrence of postoperative respiratory failure. Overall the model shows a strong accuracy with an area under the curve of ROC analysis of 0.9 [95% confidence interval: 0.85-0.95].
Discussion:
Our study found that weight <18kg is a major risk factor for predicting a postoperative respiratory complication.