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Tonsillectomy for Obstructive Sleep-Disordered Breathing: Should They Stay, or Could They Go?
Norman R Friedman1,2, Maxene Meier3, Kaitlyn Tholen1,2
1Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado, U.S.A.
Insights
Children who no longer require oxygen 3 hours post-surgery and pass a sleep room air challenge (SRAC) can be safely discharged. This finding holds true regardless of polysomnogram (PSG) results or other health conditions.
Area of Science:
- Pediatric Surgery
- Respiratory Medicine
- Sleep Medicine
Background:
- Adenotonsillectomy for obstructive sleep-disordered breathing is common in children.
- Postoperative respiratory monitoring is crucial for safe discharge.
- Identifying reliable discharge criteria can optimize patient flow and resource utilization.
Purpose of the Study:
- To determine if children undergoing adenotonsillectomy can be safely discharged based on oxygen requirements and a sleep room air challenge (SRAC) test.
- To identify predictors of prolonged oxygen requirement (POR) post-surgery.
- To evaluate the role of polysomnogram (PSG) results and comorbidities in discharge decisions.
Main Methods:
- A prospective, cross-sectional study of 484 children undergoing adenotonsillectomy for obstructive sleep-disordered breathing.
- Patients were monitored overnight, and demographic, clinical, and PSG data were collected.
- Logistic regression and receiver operating characteristic (ROC) curves were used to analyze prolonged oxygen requirement (POR) and identify risk factors.
Main Results:
- 75% of participants did not experience POR or adverse respiratory events.
- Asthma diagnosis and awake SpO2 < 96% were significant risk factors for POR.
- Children without asthma and with SpO2 ≥ 96% had an 18% probability of POR; age, obesity, and apnea/hypopnea index were not associated with POR.
Conclusions:
- Children who are off oxygen within 3 hours of surgery and pass a SRAC are safe for respiratory discharge.
- Discharge decisions can be made irrespective of PSG findings, age, obesity, asthma, or apnea/hypopnea index.
- Further research is needed to validate these findings in broader pediatric populations.
Objectives/Hypothesis:
Children who do not require oxygen beyond 3 hours after surgery and pass a sleep room air challenge (SRAC) are safe for discharge regardless of polysomnogram (PSG) results or comorbidities.
Study Design:
Cross-sectional prospective study.
Methods:
All children observed overnight undergoing an adenotonsillectomy for obstructive sleep-disordered breathing were prospectively recruited. Demographic, clinical, and PSG characteristics were stratified by whether the patient had required oxygen beyond 3 hours postoperatively (prolonged oxygen requirement [POR]) and compared using t test, chi-squared test, or Fisher's exact test depending on distribution. Optimal cut points for predicting POR postsurgery were calculated using receiver operating characteristic curves. The primary analysis was performed on the full cohort via logistic regression using POR as the outcome. Significant characteristics were analyzed in a logistic regression model, with significance set at P < .05.
Results:
A total of 484 participants met the inclusion criteria. The mean age was 5.65 (standard deviation = 4.02) years. Overall, 365 (75%) did not have a POR or any other adverse respiratory event. In multivariable logistic regression, risk factors for POR were an asthma diagnosis (P < .001) and an awake SpO2 <96% (P = .005). The probability of a POR for those without asthma and a SpO2 ≥ 96% was 18% (95% confidence interval: 14-22). Age, obesity, and obstructive apnea/hypopnea index were not associated with POR.
Conclusions:
In conclusion, all children in our study who are off oxygen within 3 hours of surgery and passed a SRAC were safe for discharge from a respiratory standpoint regardless of age, obesity status, asthma diagnosis, and obstructive apnea/hypopnea index. Additional investigations are necessary to confirm our findings.
Level Of Evidence:
3 Laryngoscope, 132:1675-1681, 2022.
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