Related Experiment Video
Updated: Aug 7, 2026
CO2-Lasertonsillotomy Under Local Anesthesia in Adults
Published on: November 6, 2019
Social Determinants of Preoperative Polysomnography and Surgical Outcomes in Pediatric Tonsillectomy
Austin Bridges1, Varun Pasapula1, Zoe Zhang1
1Department of Otolaryngology-Head and Neck Surgery UT Southwestern Medical Center Dallas Texas USA.
Insights
Sociodemographic and neighborhood factors influence preoperative polysomnography (PSG) use in children undergoing tonsillectomy, but do not impact surgical success. Equity in pediatric tonsillectomy access is key.
Area of Science:
- Pediatric Otolaryngology
- Health Services Research
- Health Equity
Background:
- Tonsillectomy is a common pediatric surgery, often indicated for sleep-disordered breathing.
- Preoperative polysomnography (PSG) aids in diagnosis and surgical planning.
- Understanding disparities in PSG utilization is crucial for equitable care.
Purpose of the Study:
- To investigate associations between sociodemographic/neighborhood factors and preoperative PSG use in children undergoing tonsillectomy.
- To assess if these factors influence postoperative PSG, surgical success, or complications.
Main Methods:
- Analysis of 940 children undergoing tonsillectomy (2016-2024) at a tertiary children's hospital.
- Multivariable logistic regression to assess sociodemographic (race, insurance, language) and neighborhood (Child Opportunity Index) factors.
- Sequential and doubly robust models to examine pathways and complications.
Main Results:
- 41.4% of children received preoperative PSG.
- Black race, non-English language, Medicaid insurance, and lower Child Opportunity Index were linked to higher PSG odds.
- Obesity and medical complexity strongly predicted preoperative PSG use.
- Preoperative PSG was associated with increased complication odds, likely due to confounding by indication.
Conclusions:
- Sociodemographic and neighborhood factors are associated with preoperative PSG utilization.
- These factors did not affect surgical success or return for postoperative PSG.
- Ensuring equitable access to tertiary surgical evaluation is a critical equity concern.
Objective:
To evaluate how sociodemographic and neighborhood factors are associated with use of preoperative polysomnography (PSG) in children undergoing tonsillectomy, and to assess whether these factors are associated with return for postoperative PSG, surgical success, or postoperative complications.
Methods:
We analyzed 940 children undergoing tonsillectomy at a tertiary children's hospital (2016-2024). Multivariable logistic regression estimated associations between sociodemographic factors (race, ethnicity, insurance, language), neighborhood opportunity (Child Opportunity Index [COI]), and preoperative PSG. Sequential models examined pathways of association. Doubly robust models estimated the association between PSG and postoperative complications.
Results:
Preoperative PSG was performed in 389 of 940 children (41.4%). In adjusted models, Black race (adjusted odds ratio [aOR], 1.79; 95% CI, 1.18-2.72), non-English language (aOR, 2.26; 95% CI, 1.45-3.52), Medicaid insurance (aOR, 1.52; 95% CI, 1.06-2.17), and lower COI (aOR per 1-SD increase, 0.81; 95% CI, 0.67-0.99) were associated with higher odds of having preoperative PSG prior to tonsillectomy. Obesity was also strongly associated with preoperative PSG (aOR, 2.49; 95% CI, 1.77-3.51), second only to medical complexity. The association for Hispanic ethnicity attenuated by approximately 80% in sequential models. Sociodemographic and neighborhood factors were not associated with return for postoperative PSG or surgical success; those outcomes were associated with preoperative apnea-hypopnea index (AHI) and medical complexity. In doubly robust models, preoperative PSG was associated with higher complication odds (aOR, 2.07; 95% CI, 1.09-3.93), consistent with confounding by indication rather than a causal effect of testing.
Conclusion:
Social and neighborhood factors were associated with preoperative PSG use but not with surgical success. The critical equity question in pediatric tonsillectomy may lie upstream, in who reaches tertiary surgical evaluation at all.
Level Of Evidence:
4.
Related Concept Videos
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:23Chronic Pharyngitis
Etiology
It often arises from persistent viral or bacterial infections affecting sinuses and tonsils.
Additional contributing factors include inadequate dental hygiene, mouth breathing, recurring tonsillitis, allergic rhinitis, laryngopharyngeal reflux, and exposure to smoke, chemicals, and other environmental pollutants. Allergic reactions to pollen, mold, and pet dander, chronic cough, excessive voice usage,...
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...