title: Predictors of perioperative complications in higher risk children after adenotonsillectomy for obstructive sleep apnea: a prospective study.
abstract: OBJECTIVE
  Retrospective studies have limitations in predicting perioperative risk following adenotonsillectomy in children with obstructive sleep apnea syndrome (OSAS). Few prospective studies exist. We hypothesized that demographic and polysomnographic (PSG) variables would predict respiratory and general perioperative complications.
  
  
  METHODS
  Prospective, observational cohort study.
  
  
  METHODS
  Pediatric tertiary center.
  
  
  METHODS
  Consecutive children undergoing adenotonsillectomy for OSAS within 12 months of PSG were evaluated for complications occurring within 2 weeks of surgery.
  
  
  RESULTS
  There were 329 subjects, with 27% <3 years old, 24% obese, 16% preterm, and 29% with comorbidities. In this higher risk population, 28% had respiratory complications (major and/or minor), and 33% had nonrespiratory complications. Significant associations were found between PSG parameters and respiratory complications as follows: apnea hypopnea index (rank-biserial correlation coefficient [r] = 0.174, P = .017), SpO2 nadir (r = -0.332, P < .0005), sleep time with SpO2 <90% (r = 0.298, P < .0005), peak end-tidal CO2 (r = 0.354, P < .0005), and sleep time with end-tidal CO2 >50 mm Hg (r = 0.199, P = .006). Associations were also found between respiratory complications and age <3 years (r = -0.174, P = .003) or black race (r = 0.123, P = .039). No significant associations existed between PSG parameters and nonrespiratory complications. A model using age <3 years, SpO2 nadir, and peak CO2 predicted respiratory complications better than the American Academy of Pediatrics or American Academy of Otolaryngology-Head and Neck Surgery Foundation guidelines but was imperfect (area under the curve = 0.72).
  
  
  CONCLUSIONS
  Thus, PSG predicted perioperative respiratory, but not nonrespiratory, complications in children with OSAS. Age <3 years or black race are high-risk factors. Present guidelines have limitations in determining the need for postoperative admission.
authors.affiliation: Sleep Center, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA Bangkok Pattaya Hospital, Chonburi, Thailand Sleep Disorder Center, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Anchana
authors.initials: A
authors.lastname: Thongyam
authors.affiliation: Sleep Center, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Carole L
authors.initials: CL
authors.lastname: Marcus
authors.affiliation: Anesthesia and Critical Care Medicine Department, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Justin L
authors.initials: JL
authors.lastname: Lockman
authors.affiliation: Sleep Center, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Mary Anne
authors.initials: MA
authors.lastname: Cornaglia
authors.affiliation: Division of Otolaryngology, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Aviva
authors.initials: A
authors.lastname: Caroff
authors.affiliation: Clinical and Translational Research Center, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Gallagher
authors.affiliation: Clinical and Translational Research Center, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Justine
authors.initials: J
authors.lastname: Shults
authors.affiliation: Sleep Center, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Joel T
authors.initials: JT
authors.lastname: Traylor
authors.affiliation: Division of Otolaryngology, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Rizzi
authors.affiliation: Division of Otolaryngology, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA elden@email.chop.edu.
authors.forename: Lisa
authors.initials: L
authors.lastname: Elden
mesh_terms: D000233:Adenoidectomy / Q000009:adverse effects* / Q000379:methods; D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric; D006801:Humans; D015994:Incidence; D008297:Male; D017286:Polysomnography / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000601:surgery*; D014068:Tonsillectomy / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome
keywords: adenotonsillectomy; obstructive sleep apnea; polysomnography