Postoperative respiratory complications and racial disparities following inpatient pediatric tonsillectomy: A cross-sectional study
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Published on: May 28, 2014
Yann-Fuu Kou1, Mark Sakai1, Gopi B Shah1,2
1Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.
Insights
African American children experienced higher rates of respiratory complications after inpatient tonsillectomy. Further research is needed to understand and address these disparities in pediatric respiratory events.
Area of Science:
- Pediatric surgery
- Respiratory medicine
- Health disparities research
Background:
- Tonsillectomy is a common pediatric procedure.
- Respiratory complications can occur post-tonsillectomy.
- Understanding risk factors and disparities is crucial for patient safety.
Purpose of the Study:
- To determine the incidence of respiratory complications and interventions following inpatient tonsillectomy in the United States.
- To identify risk factors associated with these respiratory events.
- To investigate potential racial disparities in complication rates.
Main Methods:
- Retrospective review of the Kids Inpatient Database (2006, 2009, 2012).
- Analysis of respiratory events (complications/interventions) in children under 18.
- Statistical analysis including Pearson chi-square and logistic regression to identify risk factors and racial disparities.
Main Results:
- The study included 30,617 pediatric patients.
- Overall complication rate was 6.0%, and intervention rate was 3.6%.
- African American children had significantly higher odds of respiratory events (OR: 1.5) compared to white children (OR: 0.8) after adjusting for covariates.
Conclusions:
- Respiratory events, though uncommon, were more frequent in African American children post-tonsillectomy.
- Significant racial disparities in respiratory complication rates were observed.
- Further investigation into the causes of these disparities is warranted to improve pediatric care.
Objectives/Hypothesis:
To study rates of respiratory complications/interventions among inpatient tonsillectomy patients in the United States and identify risk factors for these events.
Study Design:
Retrospective database review.
Methods:
Children (age < 18 years) undergoing tonsillectomy with or without adenoidectomy in 2006, 2009, and 2012 were studied using the Kids Inpatient Database, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Outcomes were analyzed for respiratory events (complications/interventions) and racial disparities. Pearson χ test was used to analyze categorical data and regression analysis was used for continuous variables. Respiratory events were analyzed by racial identity using logistic regression analysis. A P < .05 was considered significant.
Results:
The study included 30,617 patients (41% female, 51% white, 24% African American, 23% Hispanic, 3.0% Asian). The mean age was 5.2 years, and mean length of stay 2.3 days. The overall complication rate was 6.0%, and overall intervention rate was 3.6%. Respiratory events were more common among African American children (odds ratio [OR]: 1.5, 95% confidence interval [CI]: 1.3-1.6) and less common among white children (OR: 0.8, 95% CI: 0.8-0.9). These differences were significant after controlling for age, gender, obesity, obstructive sleep apnea, and asthma. The mortality rate was 0.05% with no ethnic predilection.
Conclusions:
Respiratory events after inpatient tonsillectomy included laryngo/bronchospasm, pneumonia, pulmonary edema, intubation, prolonged intubation, and ventilation. Although uncommon, these were more common among African American children. Further research is needed to understand the etiology of this disparity.
Level Of Evidence:
NA Laryngoscope, 129:995-1000, 2019.
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