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Morbidity and mortality from adenotonsillectomy in children with trisomy 21

Justin Cottrell1, Siraj K Zahr1, Evan J Propst1

  • 1Department of Otolaryngology - Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.

International Journal of Pediatric Otorhinolaryngology
|November 6, 2020
PubMed

Insights

Adenotonsillectomy in children with trisomy 21 has a 31.5% complication rate, primarily respiratory issues. Understanding these risks is crucial for informed surgical decisions in this population.

Area of Science:

  • Otolaryngology
  • Pediatric Surgery
  • Genetics

Background:

  • Adenotonsillectomy (AT) is a common procedure for children with trisomy 21.
  • Outcomes following AT in this population can be variable, necessitating better risk assessment.

Purpose of the Study:

  • To characterize morbidity and mortality risk factors associated with AT in children with trisomy 21.
  • To provide accurate information for risk-benefit discussions regarding AT for patients with trisomy 21.

Main Methods:

  • Retrospective chart review of children with trisomy 21 who underwent AT (1992-2019).
  • Primary outcome: 30-day post-operative complication rate.
  • Secondary outcomes: intraoperative complications, hospital stay duration, ED visits, readmissions, reoperations, and treatment failures.

Main Results:

  • 31.5% of 251 children experienced post-operative complications requiring intervention.
  • Most common complications: respiratory issues (53.8%), poor oral intake (37.2%), and bleeding (17.9%).
  • Factors associated with increased respiratory complications included sleep-disordered breathing, high ASA score, severe obstructive sleep apnea, preoperative ICU admission, and aerodigestive comorbidities. No mortalities were observed.

Conclusions:

  • Adenotonsillectomy in children with trisomy 21 is associated with a significant morbidity rate of 31.5%.
  • Identifying risk factors aids in anticipating and managing postoperative complications in this vulnerable group.
  • Findings support informed decision-making for patients and caregivers considering AT.
Abstract

Keywords:
AdenotonsillectomyObstructive sleep apneaPediatricSleep disordered breathingTrisomy 21

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