Continuous oximetry monitoring in children admitted after adenotonsillectomy, an observational study

Children undergoing adenotonsillectomy (AT) are frequently admitted overnight because of concerns regarding postoperative respiratory events. The current admission guidelines are largely based on retrospective data. Continuous overnight oximetry may better define the incidence and severity of clinically meaningful postoperative desaturation. We sought to determine the incidence of significant overnight oxygen desaturation (SpO₂ <85% for >30 s) or supplemental oxygen requirement in non-syndromic children admitted for AT.

This prospective observational study was conducted at the Texas Children's Hospital, a tertiary freestanding pediatric hospital. Consecutive patients admitted following AT between July 26, 2024, and May 27, 2025, were assessed for eligibility. Patients with fewer than 4 h of overnight oximetry data were excluded. The final analysis included 147 non-syndromic children, including those younger than 3 years, those with severe obstructive sleep apnea confirmed by preoperative polysomnography, and those with morbid obesity (BMI >99th percentile) who were admitted for postoperative observation. Patients with significant comorbidities, genetic syndromes, or craniofacial abnormalities were enrolled but were analyzed separately as a supplementary cohort. The primary outcomes were the incidence and frequency of severe oxygen desaturation events (SpO₂ <85% for >30 s) and the requirement for overnight supplemental oxygen.

Of the 508 patients assessed for eligibility, 315 were enrolled, and 147 non-syndromic children met the inclusion criteria for the primary analysis. Among these patients, 57.8% were male, with a median age of 7.0 years, median weight of 40.6 kg, and median BMI of 25.0 kg/m²; 70.7% were classified as obese (BMI >95th percentile). Thirteen patients (8.8%) experienced at least one severe overnight desaturation event (SpO₂ <85% for >30 s), whereas 11 patients (7.5%) required supplemental overnight oxygen because of sustained desaturation. Patients with at least one severe desaturation event experienced a greater number of moderate desaturation events (median 12.0 vs. 2.5 events; p = 0.045) and longer moderate desaturation duration (72.0 vs. 32.4 s per event; p = 0.01) than those without severe events. The need for supplemental oxygen in the postanesthesia care unit was strongly associated with the need for supplemental oxygen overnight (odds ratio 12.1; 95% CI, 4.3-34.27; p < 0.001).

In this prospective observational study of non-syndromic children admitted following AT surgery, a small subset of non-syndromic children experienced severe ≥1 severe desaturation events (SpO₂ <85% for >30 s) overnight after AT. Further investigation is warranted to elucidate the factors predicting severe desaturation following AT surgery. PACU oxygen was associated with the need for overnight supplemental oxygen. This study suggests that patients with preoperative URI symptoms or those requiring supplemental oxygen in the PACU should be considered for overnight observation.