title: Risk factors for desaturation after tonsillectomy: analysis of 4092 consecutive pediatric cases.
abstract: OBJECTIVE
  To identify clinical risk factors for oxygen desaturation in the first 24 hours post-tonsillectomy, thus permitting the identification of those patients who warrant inpatient monitoring.
  
  
  METHODS
  A retrospective analysis of 4092 consecutive patients undergoing tonsillectomy over a two-year period.
  
  
  METHODS
  Detailed clinical data were recorded for all patients who desaturated in the postoperative period (n = 294) and randomly selected controls (n = 368). Univariate and multivariate analysis was performed in order to identify independent risk factors for desaturation.
  
  
  RESULTS
  There were 294/4092 patients (7.2%) who experienced desaturations (defined as sustained saturations <90%) in the first 24 hours postoperatively (mean nadir, 78.7%). Multivariate analysis identified seven independent clinical risk factors for desaturation in the initial 24 hours post-tonsillectomy: trisomy 21, weight, coexistent cardiac disease, a coexistent syndromic diagnosis, a clinical diagnosis of obstructive sleep apnea (OSA), a coexistent neurologic diagnosis, and a prior diagnosis of pulmonary disease. A policy that admits all patients exhibiting any one of these risk factors except OSA would have identified 92% of the patients who subsequently desaturated. However, such a policy would also have required admission of 60% of the patients in our control group.
  
  
  CONCLUSIONS
  These findings are generally consistent with the Clinical Practice Guidelines recently published by the American Academy of Otolaryngology. In a tertiary care center, it may not be possible to identify an algorithm that admits all children at risk of desaturation while permitting the discharge of a high percentage of patients.
  
  
  METHODS
  3b.
authors.affiliation: Department of Otolaryngology, Children's Hospital Boston, Boston, Massachusetts; Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts.
authors.forename: Stephen
authors.initials: S
authors.lastname: Kieran
authors.forename: Caroline
authors.initials: C
authors.lastname: Gorman
authors.forename: Alexann
authors.initials: A
authors.lastname: Kirby
authors.forename: Naomi
authors.initials: N
authors.lastname: Oyemwense
authors.forename: Lina
authors.initials: L
authors.lastname: Lander
authors.forename: Margot
authors.initials: M
authors.lastname: Schwartz
authors.forename: David
authors.initials: D
authors.lastname: Roberson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D015999:Multivariate Analysis; D010100:Oxygen / Q000097:blood*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000453:epidemiology; D014068:Tonsillectomy
chemical_list: D010100:Oxygen
keywords: Tonsillectomy; adenotonsillectomy; monitoring; obstructive sleep apnea; oxygen desaturation; polysomnography; respiratory complications; sleep; sleep-disordered breathing