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Overnight Monitoring After T&A for Children Ages 24-36 Months: Is It Always Necessary?
Tyler Van Heest1,2, Luka Bahra3, Suhong Tong4
1Pediatric ENT and Facial Plastic Surgery, Children's Minnesota, Minneapolis, Minnesota, USA.
Insights
Children under 3 years old who stop needing oxygen within 3 hours and pass an asleep room air challenge (AsRAC) after tonsillectomy (T+/-A) are safe for same-day discharge. Chronic lung disease (CLD) is a risk factor for prolonged oxygen requirement (POR).
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Respiratory Medicine
Background:
- Tonsillectomy with or without adenoidectomy (T+/-A) is a common pediatric surgical procedure.
- Postoperative oxygen requirement can prolong hospital stays for young children.
- Identifying safe criteria for same-day discharge is crucial for optimizing pediatric surgical care.
Purpose of the Study:
- To evaluate the safety of same-day discharge for children under 3 years old after T+/-A.
- To determine if weaning off oxygen within 3 hours and passing an asleep room air challenge (AsRAC) are reliable indicators for discharge.
- To identify risk factors for prolonged oxygen requirement (POR) in this patient population.
Main Methods:
- Retrospective study of 645 children aged 24-36 months undergoing T+/-A from 2019-2021.
- Analysis of demographic, clinical, and polysomnography (PSG) data.
- Stratification based on prolonged oxygen requirement (POR) and statistical comparison using Kruskal-Wallis and Chi-squared/Fisher's Exact tests.
Main Results:
- 81.2% of children weaned off oxygen within 3 hours post-surgery.
- Of those off oxygen within 3 hours, 98.7% did not require re-oxygenation.
- Female sex and chronic lung disease (CLD) were significant risk factors for POR; preoperative PSG variables did not predict POR.
Conclusions:
- Children aged 24-36 months who wean off oxygen within 3 hours and pass an AsRAC are suitable candidates for same-day T+/-A surgery.
- CLD is the primary clinical risk factor for prolonged oxygen requirement.
- Preoperative polysomnography findings do not reliably predict postoperative oxygen needs.
Objectives:
To determine whether children < 3 years of age who do not require oxygen beyond 3 h and pass an asleep room air challenge (AsRAC), defined as maintaining a SpO2 of ≥ 90% for 20 min during sleep, would be safe for discharge after tonsillectomy with or without adenoidectomy (T+/-A).
Methods:
All children aged 24-36 months undergoing T+/-A from 2019 to 2021 were included. Demographic, clinical, and polysomnography (PSG) results were stratified based on the presence of a prolonged oxygen requirement (POR) and compared using the Kruskal-Wallis test for continuous variables and Chi-squared test or Fisher's Exact tests for categorical variables. Univariate and multiple logistic models were performed.
Results:
A total of 645 children were included. Overall, 524 (81.2%) successfully weaned from oxygen within 3 h of surgery, and 517 (98.7%) of patients who were off oxygen within 3 h never went back on oxygen during the monitoring period. Patient sex (OR = 1.88 [95% CI, 1.19-2.96]; p = 0.006) and diagnosis of chronic lung disease (CLD) (OR = 13.41 [95% CI, 3.69-48.81]; p < 0.0001) were the only statistically significant risk factors associated with a POR. No association was found between any of the preoperative PSG variables and a POR.
Conclusions:
Children between the ages of 24- and 36-months undergoing T+/-A who have weaned off oxygen within 3 h after surgery and passed an AsRAC would be candidates for same-day surgery. CLD was the only clinically relevant risk factor for a POR, and no preoperative PSG variables predicted POR.
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