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Published on: November 6, 2019
Outcomes and considerations in children with developmental delay undergoing tonsillectomy
Jordan B Luttrell1, Chad A Nieri1, Madhu Mamidala1
1Department of Otolaryngology - Head and Neck Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
Insights
Children with developmental delay (DD) face significantly higher post-tonsillectomy complication rates. This highlights the need to incorporate DD into pre-operative risk assessments and patient counseling for improved surgical outcomes.
Area of Science:
- Pediatric Surgery
- Developmental Pediatrics
- Healthcare Outcomes Research
Background:
- Developmental delay (DD) affects 1 in 6 children, leading to increased healthcare utilization.
- Children with DD may experience a higher rate of complications and costs.
- Tonsillectomy is a common procedure in children, necessitating an understanding of associated risks.
Purpose of the Study:
- To compare post-operative complications in children with and without developmental delay (DD) undergoing tonsillectomy.
- To identify specific risk factors and comorbidities associated with DD in this patient population.
- To inform pre-operative counseling and decision-making for children with DD.
Main Methods:
- Retrospective chart review of 400 children undergoing tonsillectomy over one year.
- Data collected included demographics, polysomnograms, comorbidities, complications, and length of stay.
- Children with a pre-existing or ongoing diagnosis of DD were compared to controls.
Main Results:
- The developmental delay (DD) group (n=56) had a significantly higher complication rate (32.14%) compared to controls (8.72%) (p < 0.00001).
- Children with DD exhibited higher incidences of comorbidities (p < 0.00001) and prematurity (p < 0.00001).
- No significant difference in length of stay (p=0.33) or complications if premature (p=0.22) was observed between groups.
Conclusions:
- Children with DD face substantially higher risks of post-tonsillectomy complications.
- The increased risk is linked to higher rates of comorbidities and prematurity in the DD population.
- Findings underscore the importance of including DD in pre-operative evaluations and counseling for this high-risk group.
Introduction:
Developmental delay (DD) affects one in six children and has been shown to require more health care than the average child [1-2]. Certain recent studies have suggested an increased rate of complications/costs in children with DD [3-5]. Our objective was to perform a retrospective study comparing DD children to non-DD controls in patients presenting for tonsillectomy over a 1-year period to further define the relationship between DD and post-operative complications.
Methods:
We conducted a retrospective chart review of children undergoing tonsillectomy over a one-year period. We collected demographic information, polysomnogram, comorbidities, complications, and length of stay. A diagnosis of developmental delay was considered if recorded prior to the tonsillectomy or workup was ongoing at the time of tonsillectomy. All data was analyzed using IBM SPSS Statistics 25.
Results:
The final cohort included 400 patients. Our cohort had 56 patients with diagnosis of DD. We recorded 18 complications in the DD population (32.14%) compared to 30 complications in the control group (8.72%) (p < 0.00001). Children with DD had higher incidence of comorbidities (p < 0.00001), complication with comorbidities (p < 0.00001), and incidence of prematurity (p < 0.00001); whereas, they did not have increased length of stay (LOS) (p = 0.33) or complications if premature (p = 0.22). Pre-operative polysomnogram was associated with higher incidence of complication (p = 0.035) in the total population but children with DD did not have higher pre-operative obstructive apnea-hypopnea index (oAHI)compared to the control patients (p = 0.25).
Conclusion:
Children with DD were found to have a significantly higher complication rate compared to children without DD in our patient population. They did have higher incidence of additional comorbidities and prematurity. This elevated risk should at least be included in pre-operative counseling, but additionally has potential implications for pre-operative decision making and treatment plans in this high-risk population.
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