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Is Surgical Treatment for Obstructive Sleep Apnea in Infants and Toddlers Safe? A Retrospective Comparative Analysis
Daniel Levi1, Daniel Yafit1, Aviad Sapir1
1Department of Otolaryngology-Head & Neck Surgery, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Insights
Pediatric obstructive sleep apnea surgery is generally safe for infants and toddlers, though it may involve longer hospital stays. Higher reoperation rates in younger children underscore the need for extended follow-up and parental awareness of symptom recurrence.
Area of Science:
- Pediatric surgery
- Otolaryngology
- Sleep medicine
Background:
- Obstructive Sleep Apnea Disorder (OSAD) significantly impacts pediatric health.
- Surgical interventions are common for pediatric OSAD, but safety in infants and toddlers requires specific evaluation.
Purpose of the Study:
- To evaluate the safety and outcomes of Obstructive Sleep Apnea Disorder (OSAD) surgery in infants and toddlers.
- Compare surgical outcomes across different pediatric age groups.
Main Methods:
- Retrospective cohort study of 419 pediatric patients undergoing OSAS surgery.
- Patients categorized into infants (≤1 year), toddlers (1-2 years), and controls (≥2 years).
- Outcomes assessed included PICU admissions, LOS, ER visits, fever, bleeding, and reoperation rates.
Main Results:
- Infants and toddlers experienced longer LOS and higher PICU admissions compared to controls, though differences were not statistically significant after adjusting for surgical type.
- No significant differences were found in ER visits, fever, or bleeding across age groups.
- Reoperation rates were significantly higher in toddlers (25.2%) and infants (16.4%) compared to controls (6.2%).
Conclusions:
- Surgery for OSAD in children under 2 years is generally safe but associated with increased hospital stay.
- Higher reoperation rates in this young demographic necessitate extended monitoring and robust parental education on symptom recurrence.
Objective:
To assess if surgery for Obstructive Sleep Apnea Disorder (OSAD) is safe for infants and toddlers.
Methods:
Retrospective cohort study of paediatric patients undergoing OSA surgery; partial or complete tonsillectomy with adenoidectomy, tonsillectomy without adenoidectomy and adenoidectomy. Patients were divided into three groups: infants (≤ 1 year), toddlers (1-2 years) and control (children ≥ 2 years). The study measured outcomes such as paediatric intensive care unit (PICU) admissions, length of hospital stay (LOS), emergency room (ER) visits within 2 weeks of surgery, fever, dehydration, bleeding and the need for reoperation.
Results:
A total of 419 paediatric patients were included: 61 infants (14.5%), 147 toddlers (35.1%) and 211 controls (50.4%). Adenoidectomy was the most common procedure for infants (75%), followed by toddlers (52%) and controls (27%). The LOS was significantly longer in the infant group (p < 0.001). PICU admissions were higher in infants compared to the control group (p < 0.001). However, after adjusting for the type of surgery, no statistical difference was found. Additionally, there were no significant differences in the relative risk of ER visits, fever, or bleeding between the groups. A total of 60 patients (14.3%) in the cohort underwent reoperations, with higher rates in toddlers compared to infants and controls (25.2%, 16.4% and 6.2%, respectively, p < 0.001). The most common revision surgery for the control group was adenoidectomy (8/13, 61.5%), while for toddlers and infants, the most common revision surgery was adenoidectomy + tonsillectomy (22/37, 59.45% and 5/10, 50%, respectively). However, after adjusting for the type of surgery, no statistical difference was found.
Conclusion:
OSA surgery in children aged ≤ 2 years is generally safe but carries risks, including longer hospital stays. The higher rate of reoperations in this age group highlights the need for longer follow-up and parental education about the recurrence of clinical symptoms.
