Characterizing Post Tonsillectomy Respiratory Complications in Patients Under Three
Nathan E. Lu, Fendi Obuekwe, Amber D. Shaffer, Marina V. Rushchak, Amanda L. StapletonABSTRACT
Objective
To characterize the postoperative respiratory complications in children < 3 years old who underwent tonsillectomy.
Methods
Retrospective chart review of patients < 3 years old at time of tonsillectomy. Demographics, comorbidities, polysomnography results, intraoperative factors, and postoperative respiratory complications (desaturations (< 88%) and airway interventions) were collected. Postoperative respiratory complications in all and otherwise healthy patients (without significant comorbidities or perioperative illness) were analyzed using Wilcoxon rank‐sum and multivariable logistic regression.
Results
498 patients included. Demographics revealed male (56.4%), white (82.9%), severe sleep apnea (30.0%), prematurity (12.9%), and genetic disorders (12.7%). Prematurity ( p = 0.04), bronchopulmonary dysplasia/chronic lung disease ( p = 0.02), pre‐operative AHI ( p = 0.006), OAHI ( p = 0.01), % total sleep time < 90% O 2 ( p = 0.001) and O 2 nadir ( p = 0.001), and intraoperative laryngospasm ( p = 0.03) were associated with receiving postoperative supplemental oxygen. With the exception of some pre‐op PSG parameters, no characteristics or intraoperative complications were associated with desaturations > 4 h postoperatively. Pre‐operative AHI ( p = 0.003), OAHI ( p = 0.049), O 2 nadir ( p = 0.006), and % total sleep time < 90% O 2 ( p = 0.008) were associated with desaturations > 4 h postoperatively. Those with desaturations > 4 h postoperatively received supplemental oxygen ( p < 0.001) and had a hospital stay > 24 h ( p = 0.006). Of otherwise healthy patients, 10/291 (3.4%) had a desaturation postoperatively, with 7 receiving supplemental oxygen, and only one having had a desaturation > 4 h postoperatively (transient to 87%).
Conclusion
Otherwise healthy children < 3 years old who underwent tonsillectomy had a low risk of critical postoperative respiratory complications. Children < 3 years old without significant comorbidities or perioperative illness may not require mandatory overnight hospitalization following tonsillectomy.
Level of Evidence
3.