title: 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.affiliation: Department of Otology and Laryngology, Harvard Medical School, United States.
authors.forename: Courtney A
authors.initials: CA
authors.lastname: Hill
authors.forename: Andrea
authors.initials: A
authors.lastname: Litvak
authors.forename: Craig
authors.initials: C
authors.lastname: Canapari
authors.forename: Brian
authors.initials: B
authors.lastname: Cummings
authors.forename: Corey
authors.initials: C
authors.lastname: Collins
authors.forename: Donald G
authors.initials: DG
authors.lastname: Keamy
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Ferris
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Hartnick
mesh_terms: D000046:Academic Medical Centers; D000233:Adenoidectomy / Q000009:adverse effects / Q000379:methods*; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D018579:Patient Selection; D010865:Pilot Projects; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D012008:Recurrence; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000601:surgery*; D013997:Time Factors; D014068:Tonsillectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome