Polysomnographic variables predictive of adverse respiratory events after pediatric adenotonsillectomy.
OBJECTIVE
To determine polysomnographic (PSG) variables that may potentially predict adverse respiratory events after pediatric adenotonsillectomy.


METHODS
Retrospective, case-control study.


METHODS
Free-standing academic tertiary-care pediatric hospital.


METHODS
The study included 1131 patients undergoing adenotonsillectomy by 2 attending surgeons. There were no exclusion criteria.


METHODS
Variables from preoperative PSGs were analyzed to determine predictors of postoperative respiratory complications. Logistic regression analysis was performed.


RESULTS
A total of 151 patients (13.4%) underwent preoperative PSG. Twenty-three of these patients (15.2%) had adverse respiratory events. The primary adverse event was desaturation requiring supplemental oxygen therapy, with 1 case of postobstructive pulmonary edema. Patients with adverse events had a significantly higher apnea-hypopnea index) (31.8 vs 14.1; P = .001), higher hypopnea index (22.6 vs 8.9; P = .004), higher body mass index (z score, 1.43 vs 0.70; P = .02), and lower nadir oxygen saturation (72% vs 84%; P <.001). Patients with adverse events had a prolonged hospital course (odds ratio, 32.1; 95% confidence interval, 7.8-131.4). There were no differences in age or other PSG variables. There were no intubations or mortalities.


CONCLUSIONS
Polysomnography may be used to predict which patients are at higher risk for adverse respiratory events after adenotonsillectomy. Such knowledge is valuable for planning optimal postoperative management and intraoperative anesthesia. Predictors of increased respiratory complications include apnea-hypopnea index, hypopnea index, body mass index, and nadir oxygen saturation.
Children's National Medical Center, George Washington University School of Medicine, Washington, DC, USA.
Eric M
EM
Jaryszak
Rahul K
RK
Shah
Christopher C
CC
Vanison
Lina
L
Lander
Sukgi S
SS
Choi
D000233:Adenoidectomy / Q000009:adverse effects* / Q000379:methods; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D010101:Oxygen Consumption / Q000502:physiology; D017286:Polysomnography; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D012121:Respiration, Artificial / Q000379:methods; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D014068:Tonsillectomy / Q000009:adverse effects* / Q000379:methods