Predicting Respiratory Complications for Day Case Paediatric Adenotonsillectomy

To assess the effectiveness of a pre-operative triaging model for paediatric adenotonsillectomy in identifying risk of early post-operative respiratory complications, in order to propose an evidence-based triaging model for day-case paediatric adenotonsillectomy.

A retrospective cohort study of 2953 children between 2- and 12-years-old undergoing adenotonsillectomy for obstructive sleep apnoea (OSA) between January 2011 and December 2019. Patients were triaged as either low-risk or high-risk for post-operative respiratory complications based on age, comorbidities and results of pre-operative investigation with either overnight oximetry or polysomnography. Pre-operative factors including respiratory investigations, intra-operative factors and post-operative course were analysed.

Of the 2953 patients enrolled in this study, 1229 patients were deemed low-risk, and 1724 patients were deemed high-risk. Total respiratory complication rate in low-risk patients was 1.5% requiring either repositioning or prolonged oxygenation, with no major respiratory complications requiring admission to the intensive care unit (ICU) or non-invasive ventilation. Total respiratory complication rate in the high-risk cohort was 11.7%. In this cohort, five patients required non-invasive ventilation and seven had an unplanned admission to ICU for monitoring. Severity of OSA and the presence of recovery room complications were the most significant independent risk factors associated with post-operative respiratory compromise, with severe OSA conferring an odds ratio of 9.5 (95% CI 5.0-18.0) of respiratory compromise and 13.6 (95% CI 3.4-54.9) in the presence of any complications in the recovery room.

Pre-operative oximetry and/or polysomnography are useful tools to aid triaging patients and stratifying risk when determining safety for day-case paediatric adenotonsillectomy.