Gastroesophageal reflux as a predictor of complications after adenotonsillectomy in young children.
OBJECTIVE
To examine characteristics of young children with gastroesophageal reflux (GER) who experienced complications within the first 24h after adenotonsillectomy.


METHODS
Subset analysis of a larger retrospective cohort.


METHODS
A retrospective chart review was performed at a tertiary care children's hospital. Consecutive records of children 3 years old and younger undergoing adenotonsillectomy (AT) over a 5-year period were reviewed. Children with a clinical history of GER were selected for the study.


RESULTS
993 children were included in the initial analysis, and GER was found to be a significant independent variable predictive of early complications. 81 children with a history of GER were included in this study and 8 (9.9%) were found to have experienced complications within the first 24h. Six of the complications were airway-related; two required re-intubation within the first 24h. All 8 children with complications had symptoms of sleep-disordered breathing and two had documented severe obstructive sleep apnea (AHI 18.6 and 27.2). Seven children had other risk factors for complications after AT. Eighteen (22%) children had a prolonged length of stay (range 2-7 days); additional risk factors were present in these patients as well.


CONCLUSIONS
Knowledge of risk factors for complications following adenotonsillectomy is critical for identifying at-risk patients that may warrant closer post-operative observation. GER has been previously identified as a risk factor for complications in young children. Upon closer analysis, young children with GER who have other known risk factors may be at a further increased risk for airway complications and prolonged hospitalization. Parents of these children can be counseled on the post-operative risks and the possibility of a longer hospitalization.
Department of Otolaryngology and Communication Sciences, Division of Pediatric Otolaryngology, Medical College of Wisconsin, Milwaukee, WI, United States. mmccormick@mcw.edu
Michael E
ME
McCormick
Anthony
A
Sheyn
Michael
M
Haupert
Adam J
AJ
Folbe
D000233:Adenoidectomy / Q000009:adverse effects* / Q000379:methods; D000367:Age Factors; D000402:Airway Obstruction / Q000175:diagnosis* / Q000209:etiology; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000453:epidemiology; D006776:Hospitals, Pediatric; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D062606:Tertiary Care Centers; D013997:Time Factors; D014068:Tonsillectomy / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome
Adenoidectomy; Airway obstruction; Complications; Gastroesophageal reflux; Tonsillectomy; Young children