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Published on: November 6, 2019
Reconsidering routine admission for children under age 3 undergoing partial tonsillectomy: a prospective study
Ameen Biadsee1,2,3, Craig Nathanson4, Or Dagan5
1Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, St. Joseph Hospital, Western University, B2-501, 268 Grosvenor Street, London, ON, N6A 4V2, Canada. Ameenbiadsee@gmail.com.
Insights
Partial tonsillectomy (PT) is safe for young children with sleep disordered breathing (SDB) or obstructive sleep apnea (OSA). This study found low complication risks in children under 3 years old undergoing PT, similar to older children.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Sleep Medicine
Background:
- Partial tonsillectomy (PT) is an alternative treatment for pediatric sleep disordered breathing (SDB) and obstructive sleep apnea (OSA).
- Current guidelines do not differentiate PT risks from traditional tonsillectomy.
- Younger children (<3 years) undergoing PT are often admitted for surveillance due to perceived higher complication risks.
Purpose of the Study:
- To assess and compare the postoperative complication risks of PT in children aged 3 years and younger versus older children.
- To evaluate the safety and efficacy of PT as a treatment for SDB/OSA across different pediatric age groups.
Main Methods:
- A retrospective analysis of 92 children undergoing inpatient PT and/or adenoidectomy for SDB/OSA (2018-2020).
- A specific protocol monitored pain, oral intake, vital signs, and complications at 2, 4, 6, 8, and 24 hours post-surgery.
- Comparison of outcomes between children aged ≤3 years and those >3 years.
Main Results:
- No significant statistical differences in complications were observed between the younger (n=35) and older (n=57) age groups.
- The younger group had 2 complications, while the older group had 5; no major interventions were required for any patient.
- Key variables including pain scores, oral intake, oxygen saturation, and urine output showed no significant differences between the age groups.
Conclusions:
- Ambulatory partial tonsillectomy (PT) demonstrates a low risk of complications in pediatric patients.
- Age is not a significant factor in determining complication risk following PT for SDB/OSA.
- This study supports current practices for PT, suggesting similar safety profiles across pediatric age groups.
Background:
Partial Tonsillectomy (PT) is an alternative method to treat sleep disordered breathing (SDB) and/or obstructive sleep apnea (OSA). The current guidelines do not differentiate it from traditional tonsillectomy. Thus, children younger than 3 years old undergoing PT are admitted for surveillance similar to traditional tonsillectomy due to possible postoperative complications. The aim of this study is to assess the risks of PT in children 3 years old and younger, compared to older children.
Methods:
Children underwent inpatient partial tonsillectomy and/or adenoidectomy, due to SDB/OSA, from 2018 to 2020. A special protocol was designed, including follow-up at 2-, 4-, 6-, 8- and 24-h after surgery. Variables analyzed included visual analogue pain score, oral intake, oxygen saturation, pulse rate, postoperative hemorrhage, urine output, temperature, analgesics and fluid administration. Furthermore, major interventions were recorded. Comparison of all variables between children younger than 3 years old with older children was performed.
Results:
Ninety-two children were included; mean age of the whole cohort was 44.5 ± 21.9 months. Thirty-five (38%) children were 3-years old or younger and n = 57 (62%) were older than 3 years old, with no significant statistical difference in sex (p = 0.22). Mean age in the younger group was 25.7 ± 6.9 months, and 56.1 ± 20.1 months in the older group. In total we had 7 children with post-operative complications; 4 with fever, 3 with low intake. There were no major interventions recorded in either group. The complications were more common in the older group (n = 5) than the younger group (n = 2) without a statistical significance (p = 0.59). There were no differences in VAS, use of painkillers, oral intake, urine output, oxygen saturation and tachycardia among the two groups.
Conclusion:
This study supports that children undergoing ambulatory PT may be at low risk of complications, regardless of age.
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