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. 2023 Jun;168(6):1535-1544.
doi: 10.1002/ohn.238. Epub 2023 Jan 29.

Preoperative Predictors of Severe Respiratory Events After Tonsillectomy: Consideration for Pediatric Intensive Care Admission

Erin M Kirkham  1 , Michael P Puglia  2 , Bishr Haydar  2 , Elizabeth S Jewell  2 , Aleda M Leis  3 , Nithin Peddireddy  1 , Ronald D Chervin  4
Affiliations

Preoperative Predictors of Severe Respiratory Events After Tonsillectomy: Consideration for Pediatric Intensive Care Admission

Erin M Kirkham et al. Otolaryngol Head Neck Surg. 2023 Jun.

Abstract

Objective: Few data are available to guide postadenotonsillectomy (AT) pediatric intensive care (PICU) admission. The aim of this study of children with a preoperative polysomnogram (PSG) was to assess whether preoperative information may predict severe respiratory events (SRE) after AT.

Study design: Retrospective cohort study.

Setting: Single tertiary center.

Methods: Children aged 6 months to 17 years who underwent AT with preoperative polysomnography (2012-2018) were identified by billing codes. Data were extracted from medical records. SRE were defined as any 1 or more of desaturations <80% requiring intervention; newly initiated positive airway pressure; postoperative intubation; pneumonia/pneumonitis; respiratory code, cardiac arrest, or death. We hypothesized that SRE would be associated with age <24 months, major medical comorbidity, obesity (>95th percentile), apnea-hypopnea index (AHI) ≥ 30, and O2 nadir <70% on PSG. Analysis was performed with multivariable logistic regression.

Results: Of 1774 subjects, 28 (1.7%) experienced SRE. Compared to those without, children with SRE were on average younger (3 vs 5 years, p < .01) with a greater probability of medical comorbidities (59% vs 18%, p < .001). After adjustment for sex, black race, obesity, and age <24 months, children with major medical comorbidity were more likely than other children to have SRE (odds ratio [OR]: 14.2; 95% confidence interval [CI]: [5.7, 35.2]), as were children with AHI ≥ 30 (OR: 7.7 [3.0, 19.9]), or O2 nadir <70% (OR 6.1 [2.1, 17.9]). Age, obesity, sex, and black race did not independently predict SRE.

Conclusion: PICU admission may be most prudent for children with complex medical co-morbidities, high AHI (>30), and/or low O2 nadir (<70%).

Keywords: ICU; complications; pediatric; respiratory; tonsillectomy.

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Figures

Figure 1.
Figure 1.. Inclusion and Exclusion
* We did not exclude patients who also underwent a minor procedure if it was not expected to complicate their postoperative course (e.g. exam under anesthesia, myringotomy and tubes) or those who had a coincident diagnostic imaging study that is typically <30 minutes in duration
See this image and copyright information in PMC

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