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Respiratory Complications of Adenotonsillectomy for Obstructive Sleep Apnea in the Pediatric Population
G Marrugo Pardo1,2, L F Romero Moreno3, P Beltrán Erazo3
1Titular Professor, Department of Otorhinolaryngology, Universidad Nacional de Colombia, Bogotá, Colombia.
Insights
Postoperative respiratory complications after adenotonsillectomy for obstructive sleep apnea (OSA) in children at high altitudes are uncommon. An Apnea Hypopnea Index (AHI) over 44/h may indicate a higher risk for complications.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Pulmonology
Background:
- Obstructive sleep apnea (OSA) is a common condition in children requiring surgical intervention.
- Adenotonsillectomy is a primary treatment for pediatric OSA.
- Understanding postoperative risks is crucial, especially in high-altitude environments.
Purpose of the Study:
- To determine the prevalence of early postoperative respiratory complications in children with OSA undergoing adenotonsillectomy.
- To identify risk factors for these complications.
- To establish recommendations for postoperative monitoring in high-altitude settings.
Main Methods:
- Retrospective cohort study of 167 children diagnosed with OSA via polysomnogram (PSG).
- Adenotonsillectomy performed for OSA treatment.
- Exclusion of patients with craniofacial malformations, obesity, or severe cardiovascular comorbidities.
- Analysis of respiratory complications within 24 hours post-surgery, correlated with OSA severity (AHI, NADIR).
- Study conducted in Bogotá, Colombia (2,640 m.a.s.l.).
Main Results:
- A total of 167 children (mean age 5.3 years) underwent adenotonsillectomy.
- The prevalence of early postoperative respiratory complications was 3.59% (6/167).
- A statistically significant association was found between respiratory complications and an Apnea Hypopnea Index (AHI) > 44/h (p < 0.04).
- No significant correlation was found for age < 3 years or NADIR < 70%.
Conclusions:
- The incidence of respiratory complications in high-altitude OSA patients is comparable to other regions.
- Preoperative AHI > 44/h is a potential risk factor for early respiratory complications.
- Ambulatory management may be suitable for select patients (age > 3 years, AHI < 44/h, NADIR > 70%) after 6-hour PACU observation at high altitudes.
Objective:
To determine the prevalence of respiratory complications in the early postoperative period of children with sleep apnea who required adenotonsillectomy at a tertiary pediatric hospital and to establish recommendations for postoperative monitoring.
Methods:
Retrospective cohort study of children with obstructive sleep apnea (OSA) diagnosed by polysomnogram (PSG), who underwent adenotonsillectomy for treatment of OSA. The prevalence of respiratory complications in the first 24 postoperative hours was measured. Patients with craniofacial malformations, obesity, and severe cardiovascular comorbidities were excluded. The prevalence of postoperative respiratory complications was compared with the severity of OSA according to the Apnea Hypopnea Index (AHI) and NADIR. All data were taken in patients residing in Bogotá city, Colombia, at 2.640 meters above sea level (m.a.s.l).
Results:
Between May 2014 and February 2017, 167 patients (108 males) required adenotonsillectomy for OSA, with an age range of 1 and 15 years (mean 5.3 years +/- 2.7). The prevalence of postoperative respiratory complications was 3.59% (6/167). There was a statistically significant relationship between the presence of respiratory complication and AHI greater than 44/h (p <0.04). There was an inverse correlation between the AHI and NADIR values. Risk groups of patients younger than 3 years and NADIR less than 70% had a higher prevalence of respiratory complications; however, this correlation was not statistically significant (p <0.08 and 0.89, respectively).
Conclusions:
The prevalence of respiratory complications in OSA patients undergoing adenotonsillectomy in high altitudes is similar to that reported in other heights. Preoperative AHI greater than 44/h could be considered a risk factor for early respiratory complication. We suggest ambulatory management after 6 hours in Postanesthetic Care Unit (PACU) observation in patients older than 3 years, with AHI less than 44/h and NADIR greater than 70% in altitudes higher than 2.500 m.a.s.l. Further research must be done to confirm this hypothesis.
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