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Postoperative complications after tonsillectomy and adenoidectomy in children with Down syndrome
N A Goldstein1, D R Armfield, L A Kingsley
1Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, PA 15213, USA.
Insights
Children with Down syndrome (DS) have a higher risk of respiratory complications and longer recovery after tonsillectomy and adenoidectomy (T&A). Overnight hospital admission is recommended for these patients post-T&A surgery.
Area of Science:
- Pediatric Otolaryngology
- Genetics and Rare Diseases
Background:
- Tonsillectomy and adenoidectomy (T&A) are common procedures in children.
- Children with Down syndrome (DS) may have unique physiological considerations impacting surgical outcomes.
Purpose of the Study:
- To compare postoperative outcomes and complications in children with Down syndrome undergoing T&A versus a control group.
- To identify specific risks associated with T&A in children with DS.
Main Methods:
- Retrospective review of medical records from January 1986 to March 1996.
- Comparison of 87 children with DS (group 1) against 64 matched controls (group 2).
- Analysis included length of hospitalization and postoperative complications.
Main Results:
- Children with DS had significantly longer hospital stays (1.6 vs 0.8 days).
- 25% of DS patients required intensive care unit (ICU) admission for airway management, compared to 0% in controls.
- Respiratory complications were 5 times more likely in the DS group.
Conclusions:
- T&A can be performed safely in children with DS, but with increased respiratory complication rates.
- Delayed oral intake and longer recovery are observed in children with DS post-T&A.
- Overnight hospitalization is recommended for children with DS after T&A due to higher complication risks.
Objective:
To compare the postoperative course and complications after tonsillectomy or tonsillectomy and adenoidectomy in children with Down syndrome (group 1) with the postoperative course and complications in children in a control group (group 2).
Design:
Retrospective review of medical records for the period January 1, 1986, through March 30, 1996.
Setting:
Tertiary care children's hospital.
Patients:
The study included 87 children in group 1 and 64 children in group 2 matched for age, sex, and year of surgery.
Intervention:
Tonsillectomy and adenoidectomy (group 1, 79 children; group 2, 57 children) and tonsillectomy (group 1, 8 children; group 2, 7 children).
Main Outcome Measures:
Length of hospitalization and postoperative complications.
Results:
The length of hospitalization was significantly increased for the children in group 1 compared with that of children in group 2 (1.6 vs 0.80 days; P=.001, Mann-Whitney U test). Twenty-two children (25%) in group 1 required airway management or observation in the pediatric intensive care unit compared with no children in group 2 who required such care (P<.001, Fisher exact test). None of the children in either group required reintubation, continuous positive airway pressure, or tracheotomy. Respiratory complications requiring intervention were 5 times more likely in group 1 (22 [25%] vs 3 [5%]; P<.001, Fisher exact test). The median time until intake of clear liquids and duration of intravenous therapy were significantly increased in group 1 compared with group 2 (5.0 vs 4.0 hours, P=.03; 23.5 vs 16.0 hours, P=.001, respectively; Mann-Whitney U test).
Conclusions:
Although tonsillectomy and adenoidectomy can be performed safely in children with Down syndrome, the rate of postoperative respiratory complications is higher and the duration until adequate oral intake is resumed is longer. We therefore recommend that children with Down syndrome be admitted to the hospital overnight after undergoing tonsillectomy and adenoidectomy.