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The Effect of Social Vulnerability on Perioperative Tonsillectomy Outcomes in Children
Salina H Goff1, Kaci Pickett-Nairne2, Thanh Nguyen3
1University of Colorado School of Medicine, Aurora, Colorado, U.S.A.
Insights
Children with higher social vulnerability face increased risk of prolonged oxygen requirement after adenotonsillectomy. This highlights the need to consider social vulnerability in perioperative care planning.
Area of Science:
- Pediatric Surgery
- Public Health
- Health Services Research
Background:
- Adenotonsillectomy is common in children for obstructive sleep-disordered breathing.
- Prolonged oxygen requirement (POR) is a potential post-operative complication.
- Social vulnerability may impact post-operative outcomes.
Purpose of the Study:
- To investigate the association between social vulnerability and POR after adenotonsillectomy.
- To inform perioperative care and discharge planning.
Main Methods:
- Reanalysis of a prospective study on children undergoing adenotonsillectomy.
- Inclusion of Social Vulnerability Index (SVI) data.
- Logistic regression analysis adjusted for covariates.
Main Results:
- 462 children included; 76% did not experience POR.
- Higher SVI quartiles were significantly associated with increased POR.
- Children in the highest SVI quartile were 2.63 times more likely to have POR.
Conclusions:
- Greater neighborhood-level social vulnerability is linked to POR post-adenotonsillectomy.
- SVI should be considered in perioperative planning for these children.
Objective:
To determine if children with greater social vulnerability are more likely to experience a prolonged oxygen requirement (POR) following adenotonsillectomy to inform the need for overnight monitoring prior to discharge.
Methods:
A previously published prospective study assessing children observed overnight following adenotonsillectomy for obstructive sleep-disordered breathing was reanalyzed including social vulnerability index (SVI). The outcome was POR beyond 3 h following extubation. Logistic regression was used to assess the association of SVI components with POR. SVI components were assessed as quartiles of cohort values. Final adjusted models included race, asthma, Down syndrome, and pre-operative SpO2.
Results:
A total of 462 children had SVI data available and were included. 354 (76.6%) were > = 3 years of age. Overall, 351 (76%) did not have a POR. The median overall SVI percentile was 26.5 (Q1 10.4, Q3 60.1). When categorized by SVI quartiles, there was a statistically significant difference with POR for overall SVI percentile (p = 0.007), SVI household composition percentile (p = 0.033), and median SVI housing/transportation percentile (p = 0.005). Individuals with an overall SVI in the 4th quartile (greatest vulnerability) were 2.63 times more likely to experience a POR than those in the 1st quartile (lowest social vulnerability) in adjusted logistic regression (95% OR CI 1.23-5.62; p = 0.01).
Conclusions:
There is a significant association between greater neighborhood-level social vulnerability and a POR following adenotonsillectomy. We propose that a child's SVI be considered when planning for the perioperative course following adenotonsillectomy.
Level Of Evidence:
3 Laryngoscope, 134:2449-2454, 2024.
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