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CO2-Lasertonsillotomy Under Local Anesthesia in Adults
Published on: November 6, 2019
Preoperative Predictors of Severe Respiratory Events After Tonsillectomy: Consideration for Pediatric Intensive Care
Erin M Kirkham1, Michael P Puglia2, Bishr Haydar2
1Department of Otolaryngology-Head & Neck Surgery, The University of Michigan, Ann Arbor, Michigan, USA.
Insights
Children undergoing adenotonsillectomy may require pediatric intensive care unit (PICU) admission if they have major medical comorbidities, an apnea-hypopnea index (AHI) over 30, or oxygen saturation below 70%. These factors predict severe respiratory events post-surgery.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Critical Care Medicine
- Sleep Medicine
Background:
- Limited data exist to guide pediatric intensive care unit (PICU) admission decisions after adenotonsillectomy (AT).
- Predicting severe respiratory events (SRE) post-AT is crucial for patient management.
Purpose of the Study:
- To assess if preoperative polysomnography (PSG) data can predict SRE in children undergoing AT.
- To identify specific preoperative factors associated with increased risk of SRE after AT.
Main Methods:
- Retrospective cohort study of 1774 children aged 6 months to 17 years who underwent AT with preoperative PSG.
- SRE defined by specific criteria including desaturations, need for positive airway pressure, intubation, pneumonia, or death.
- Multivariable logistic regression analysis to identify predictors of SRE.
Main Results:
- 1.7% of subjects experienced SRE.
- Children with SRE were younger and had higher rates of medical comorbidities.
- Major medical comorbidity (OR: 14.2), AHI ≥ 30 (OR: 7.7), and O2 nadir < 70% (OR: 6.1) were independent predictors of SRE.
- Age, obesity, sex, and race did not independently predict SRE.
Conclusions:
- PICU admission should be considered for children with complex medical comorbidities, high AHI (>30), or low O2 nadir (<70%) identified on preoperative PSG.
- Preoperative PSG findings are valuable in risk stratification for children undergoing AT.
Objective:
Few data are available to guide postadenotonsillectomy (AT) pediatric intensive care (PICU) admission. The aim of this study of children with a preoperative polysomnogram (PSG) was to assess whether preoperative information may predict severe respiratory events (SRE) after AT.
Study Design:
Retrospective cohort study.
Setting:
Single tertiary center.
Methods:
Children aged 6 months to 17 years who underwent AT with preoperative polysomnography (2012-2018) were identified by billing codes. Data were extracted from medical records. SRE were defined as any 1 or more of desaturations <80% requiring intervention; newly initiated positive airway pressure; postoperative intubation; pneumonia/pneumonitis; respiratory code, cardiac arrest, or death. We hypothesized that SRE would be associated with age <24 months, major medical comorbidity, obesity (>95th percentile), apnea-hypopnea index (AHI) ≥ 30, and O2 nadir <70% on PSG. Analysis was performed with multivariable logistic regression.
Results:
Of 1774 subjects, 28 (1.7%) experienced SRE. Compared to those without, children with SRE were on average younger (3 vs 5 years, p < .01) with a greater probability of medical comorbidities (59% vs 18%, p < .001). After adjustment for sex, black race, obesity, and age <24 months, children with major medical comorbidity were more likely than other children to have SRE (odds ratio [OR]: 14.2; 95% confidence interval [CI]: [5.7, 35.2]), as were children with AHI ≥ 30 (OR: 7.7 [3.0, 19.9]), or O2 nadir <70% (OR 6.1 [2.1, 17.9]). Age, obesity, sex, and black race did not independently predict SRE.
Conclusion:
PICU admission may be most prudent for children with complex medical co-morbidities, high AHI (>30), and/or low O2 nadir (<70%).
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