title: Predicting complications after adenotonsillectomy in children 3 years old and younger.
abstract: OBJECTIVE
  To identify risk factors for complications in the first 24h after surgery in the young (<4 years old) adenotonsillectomy patient.
  
  
  METHODS
  A retrospective chart review was performed at a tertiary care children's hospital. Consecutive records of all children of age 3 years and younger undergoing adenotonsillectomy over a 5 year period were included in the study. The main outcomes measured were total and airway complications occurring on post-operative days 0-1.
  
  
  RESULTS
  993 patients were included in the study. The mean age was 2.94 years old. Witnessed apneas (74.1%) and snoring (59.2%) were the most frequent pre-operative symptoms. 700 children were admitted with a mean length-of-stay of 1.22 days (0-9 days) and a mean time-to-oral intake of 0.28 days (0-4 days) among those patients admitted. The total number of complications was 102 in 98 patients (9.9%). There were 35 complications on post-operative days (POD) 0-1 (3.5%), and 23 of those were airway-related (2.3%). With regard to all complications on POD 0-1, significant predictors were nasal obstruction, gastroesophageal reflux disease, prematurity and a history of cardiovascular anomalies. Significant predictors of airway complications on POD 0-1 were younger age (1-2 years old), larger adenoid size, nasal obstruction, and a history of cardiovascular anomalies.
  
  
  CONCLUSIONS
  Knowing the stated risk factors for complications in the early post-operative period after adenotonsillectomy in the younger pediatric patient can help select certain patients for closer monitoring. Specifically, children aged 1-2 years old with a history of nasal obstruction from large adenoids, gastroesophageal reflux disease, prematurity, and/or cardiovascular anomalies appear to be at higher risk for early complications and should warrant closer observation.
authors: Department of Otolaryngology-Head & Neck Surgery, Wayne State University School of Medicine, Detroit, MI, United States. Michaelemccormick@gmail.com
authors: Michael E
authors: ME
authors: McCormick
authors: Anthony
authors: A
authors: Sheyn
authors: Michael
authors: M
authors: Haupert
authors: Ronald
authors: R
authors: Thomas
authors: Adam J
authors: AJ
authors: Folbe
mesh_terms: D000233:Adenoidectomy / Q000009:adverse effects* / Q000379:methods; D000367:Age Factors; D000402:Airway Obstruction / Q000209:etiology / Q000503:physiopathology; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D016017:Odds Ratio; D018579:Patient Selection; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000503:physiopathology / Q000517:prevention & control*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013997:Time Factors; D014068:Tonsillectomy / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome