Characterizing Post Tonsillectomy Respiratory Complications in Patients Under Three

To characterize the postoperative respiratory complications in children < 3 years old who underwent tonsillectomy.

Retrospective chart review of patients < 3 years old at time of tonsillectomy. Demographics, comorbidities, polysomnography results, intraoperative factors, and postoperative respiratory complications (desaturations (< 88%) and airway interventions) were collected. Postoperative respiratory complications in all and otherwise healthy patients (without significant comorbidities or perioperative illness) were analyzed using Wilcoxon rank-sum and multivariable logistic regression.

498 patients included. Demographics revealed male (56.4%), white (82.9%), severe sleep apnea (30.0%), prematurity (12.9%), and genetic disorders (12.7%). Prematurity (p = 0.04), bronchopulmonary dysplasia/chronic lung disease (p = 0.02), pre-operative AHI (p = 0.006), OAHI (p = 0.01), % total sleep time < 90% O₂ (p = 0.001) and O₂ nadir (p = 0.001), and intraoperative laryngospasm (p = 0.03) were associated with receiving postoperative supplemental oxygen. With the exception of some pre-op PSG parameters, no characteristics or intraoperative complications were associated with desaturations > 4 h postoperatively. Pre-operative AHI (p = 0.003), OAHI (p = 0.049), O₂ nadir (p = 0.006), and % total sleep time < 90% O₂ (p = 0.008) were associated with desaturations > 4 h postoperatively. Those with desaturations > 4 h postoperatively received supplemental oxygen (p < 0.001) and had a hospital stay > 24 h (p = 0.006). Of otherwise healthy patients, 10/291 (3.4%) had a desaturation postoperatively, with 7 receiving supplemental oxygen, and only one having had a desaturation > 4 h postoperatively (transient to 87%).

Otherwise healthy children < 3 years old who underwent tonsillectomy had a low risk of critical postoperative respiratory complications. Children < 3 years old without significant comorbidities or perioperative illness may not require mandatory overnight hospitalization following tonsillectomy.