Overnight Monitoring Criteria for Children with Obstructive Sleep-Disordered Breathing After Tonsillectomy: Revisited

Area of Science:

• Pediatric Otolaryngology
• Sleep Medicine
• Surgical Outcomes Research

Background:

• Previous studies suggest children passing an Asleep Room Air Challenge (AsRAC) have minimal postoperative respiratory events after adenotonsillectomy (T&A).
• Modified overnight monitoring (OM) criteria were implemented, allowing patients with an obstructive apnea/hypopnea index (OAHI) ≤20 or Class I obesity to be considered for same-day surgery (SDS) if they passed an AsRAC.

Purpose of the Study:

• To evaluate if revised OM criteria for T&A increase return visits or readmission rates within 48 hours or 15 days for SDS patients.
• To assess the impact of modified OM criteria on the rate of SDS for children with Class I obesity and those undergoing polysomnography.

Main Methods:

• Retrospective review of T&A cases in children aged 3 to <21 years from January 2017 to September 2022.
• Comparison of descriptive statistics and outcome measures using a 3% margin noninferiority test before and after the new criteria implementation.
• Analysis of emergency department (ED) revisit rates, readmissions, and perioperative respiratory events for SDS patients.

Main Results:

• The rate of T&A performed as SDS increased significantly from 58% to 74% after the criteria revision (p<0.05).
• There was no significant difference in ED revisit rates for SDS within the 3% noninferiority margin.
• SDS T&A increased by 29% for children with Class I obesity (62% vs. 33%, p<0.001) and by 19% for children with polysomnography (39% vs. 20%, p<0.001).
• Post-intervention, 0.9% of SDS patients had revisits for bleeding and 1.2% for vomiting within 48 hours; no perioperative respiratory events occurred.

Conclusions:

• Revised OM criteria for T&A are safe, as they did not lead to an increase in ED visits or readmissions within 48 hours or 15 days.
• The updated criteria facilitated a significant increase in SDS T&A for children with Class I obesity.
• The study supports the use of modified OM criteria to safely expand same-day surgery options for select pediatric T&A patients.