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Published on: December 6, 2016
Postoperative complications after adenotonsillectomy in two paediatric groups: Obstructive sleep apnoea syndrome and
Jesús Rodríguez-Catalán1, José Fernández-Cantalejo Padial1, Paula Rodríguez Rodríguez2
1Servicio de Pediatría, Hospital Universitario Fundación Jiménez Díaz, Madrid, España.
Insights
Adenotonsillectomy is safe for children, even those under 3. Most complications are minor and occur immediately post-surgery, not requiring intensive care admission.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Anesthesiology
Background:
- Adenotonsillectomy is a common procedure for treating recurrent tonsillitis and obstructive sleep apnea syndrome (OSAS).
- Previous studies suggest patients over 3 years old without comorbidities have minimal respiratory risks post-surgery.
- Data on younger children undergoing this procedure is less comprehensive.
Purpose of the Study:
- To evaluate the safety and complication rates of adenotonsillectomy in children under 3 years old.
- To confirm if the low complication rate observed in older children extends to younger pediatric populations.
- To assess the need for routine pediatric intensive care unit (PICU) admission post-adenotonsillectomy.
Main Methods:
- A retrospective observational study was conducted over 5 years.
- Included all children who underwent adenotonsillectomy at the hospital.
- Data analysis focused on complication rates, age, and reason for surgery (tonsillitis vs. OSAS).
Main Results:
- 418 children were included; 56.7% for tonsillitis, 43.3% for OSAS.
- Overall adverse events occurred in 5.7% of patients (vomiting 1.2%, bleeding 3.1%, respiratory events 1.4%).
- Respiratory events were concentrated in the immediate postoperative period, primarily in severe OSAS cases. Bleeding was more common in the tonsillitis group (P=.046). No age-related difference in complications (P=0.174).
Conclusions:
- Adenotonsillectomy demonstrates a low complication rate across different age groups, including those under 3.
- While OSAS patients had more immediate respiratory events, and tonsillitis patients had more bleeding, these were manageable.
- The findings support that routine PICU admission is generally not necessary for pediatric adenotonsillectomy patients.
Introduction And Objectives:
Adenotonsillectomy is a surgery to treat recurrent tonsillitis or obstructive sleep apnoea syndrome (OSAS). It is considered a safe procedure, with few complications. Moreover, patients over 3 years and without comorbidities do not present a higher rate of respiratory adverse events after the immediate postoperative period, and do not need systematic admission to a paediatric intensive care unit (PICU), regardless of their OSAS severity. The aim of this study is to reanalyse the situation, including patients under the age of 3 years, for whom there are fewer available data, to confirm that this trend has not changed.
Methods:
A retrospective observational study was performed, including all adenotonsillectomised children in our hospital over 5 years.
Results:
418 adenotonsillectomised children were included, 56.7% due to recurrent tonsillitis, and 43.3% because of OSAS. Only 24 patients (5%7%) experienced adverse events, of whom 1.2% had vomiting, 3.1% bleeding, and 1.4% respiratory events. All the respiratory events occurred in the operating theatre or in the post-anaesthetic unit, most frequently in children with severe OSAS, while the tonsillitis group had more bleeding (P=.046). No differences in complications were observed according to age (P=0.174), but the group of patients under three years was relatively small.
Conclusions:
No differences were found in the percentage of complications between the two groups. Although the OSAS group exhibited more respiratory events, these occurred in the immediate postoperative period; otherwise, there was a higher risk of bleeding in the tonsillitis group. These results support the findings indicating that routine PICU admission is not required for these patients.
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