A pilot study to identify pre- and peri-operative risk factors for airway complications following adenotonsillectomy for treatment of severe pediatric OSA.

Abstract

OBJECTIVE:

A pilot study to identify risk factors predicting post-operative complications in children with severe OSA undergoing adenotonsillectomy.

METHODS:

Retrospective review in a tertiary care academic institution. Two-stage least squares regression analysis and instrumental variable analysis to allow for modeling of pre- and peri-operative risk factors as having significance in predicting post-operative morbidity.

RESULTS:

Eighty-three children (mean age 4.88 ± 3.09 years) with apnea-hypopnea index (AHI) ≥ 10 who were observed overnight following adenotonsillectomy were evaluated for rates of major (increased level of care, CPAP/BiPAP use, pulmonary edema and reintubation) and minor (oxygen saturation <90%) airway complications as well as total observation costs. Major and minor complications occurred in 4.8% and 19.3% of children, respectively. Age <2 years (p<0.01), AHI >24 (p<0.05), intra-operative laryngospasm requiring treatment (p<0.05), oxygen saturations <90% on room air in PACU (p<0.05) and PACU stay >100 min (p<0.01) independently predicted post-operative complications. Children with any one of these factors experienced a 38% complication rate versus 4% in all others.

CONCLUSIONS:

This pilot study identified pre- and peri-operative risk factors that collectively can be investigated as predictors of post-operative airway complications in a prospective study. By identifying preliminary results comparing the complication rates between those children with and without these risk factors, we will be able to calculate the sample size for a future prospective validation study. Such a study is necessary to understand the safety and potential significant cost savings of observing children without risk factors on the pediatric floor and not in an ICU setting. A best practice algorithm can be created for children with severe OSA only after completing this prospective study.

• Authors: Courtney A Hill, Andrea Litvak, Craig Canapari, Brian Cummings, Corey Collins, Donald G Keamy, Timothy G Ferris, Christopher J Hartnick
• Journal: International journal of pediatric otorhinolaryngology (Int J Pediatr Otorhinolaryngol) Vol. 75 Issue 11 Pg. 1385-90 (Nov 2011) ISSN: 1872-8464 [Electronic] Ireland
• PMID: 21871668 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Topics

• Academic Medical Centers
• Adenoidectomy (adverse effects, methods)
• Age Factors
• Child
• Child, Preschool
• Cohort Studies
• Female
• Follow-Up Studies
• Humans
• Male
• Patient Selection
• Pilot Projects
• Postoperative Care (methods)
• Postoperative Complications (prevention & control)
• Predictive Value of Tests
• Preoperative Care (methods)
• Recurrence
• Regression Analysis
• Retrospective Studies
• Risk Assessment
• Severity of Illness Index
• Sleep Apnea, Obstructive (diagnosis, surgery)
• Time Factors
• Tonsillectomy (adverse effects, methods)
• Treatment Outcome