title: Indications, clinical course, and postoperative outcomes of urgent adenotonsillectomy in children.
abstract: OBJECTIVE
  Children undergoing urgent adenotonsillectomy have been poorly described in literature.
  
  
  OBJECTIVE
  To characterize the clinical course and outcomes of patients who underwent urgent adenotonsillectomy.
  
  
  METHODS
  A 7-year retrospective medical record review of patients undergoing urgent adenotonsillectomy (study group) at a tertiary care pediatric hospital was undertaken. Comparisons were made between the study group and the control group consisting of children undergoing adenotonsillectomy following diagnostic polysomnography.
  
  
  METHODS
  Retrospective medical record review with no study interventions.
  
  
  METHODS
  Demographics, hospital course, and clinical outcomes.
  
  
  RESULTS
  A total of 35 patients (21 boys [60%] and 14 girls [40%]; mean age, 3.8 years) were identified as having undergone urgent adenotonsillectomy defined as severe obstructive sleep apnea with associated hypoxemia unresponsive to oxygen. The control group included 301 patients who received a diagnostic polysomnogram prior to nonurgent adenotonsillectomy. Patients undergoing urgent adenotonsillectomy patients were more likely to be younger than 3 years (54%) than nonurgent patients (P < .001) and were characterized by elevated obstructive apnea-hypopnea indices (average, 39.4 events per hour). Persistent desaturation below 80% despite at least 0.5 L of supplemental oxygen was the most common admission indication (83%). Obesity was the most frequent comorbidity (9 patients [31%]). Two patients (6%) experienced a major postoperative complication requiring intervention. Fifteen patients (43%) were discharged with supplemental oxygen. Two patients (6%) were admitted to the hospital more than 72 hours after surgery.
  
  
  CONCLUSIONS
  Patients requiring urgent adenotonsillectomy are marked by younger age, elevated obstructive apnea-hypopnea indices, and persistent desaturations below 80% unresponsive to supplemental oxygen. Following surgery, some children have a dramatic improvement in gas exchange and will no longer require supplemental oxygen.
authors.affiliation: Department of Otolaryngology, University of Colorado School of Medicine, Aurora2Children's Hospital Colorado, Aurora.
authors.forename: Conan
authors.initials: C
authors.lastname: Liang
authors.affiliation: Department of Otolaryngology, University of Colorado School of Medicine, Aurora2Children's Hospital Colorado, Aurora.
authors.forename: Amanda G
authors.initials: AG
authors.lastname: Ruiz
authors.affiliation: Department of Otolaryngology, University of Colorado School of Medicine, Aurora2Children's Hospital Colorado, Aurora.
authors.forename: Emily L
authors.initials: EL
authors.lastname: Jensen
authors.affiliation: Department of Otolaryngology, University of Colorado School of Medicine, Aurora2Children's Hospital Colorado, Aurora.
authors.forename: Norman R
authors.initials: NR
authors.lastname: Friedman
mesh_terms: D000233:Adenoidectomy; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004630:Emergencies; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000601:surgery*; D007223:Infant; D008297:Male; D009765:Obesity / Q000150:complications; D010100:Oxygen / Q000097:blood; D010102:Oxygen Inhalation Therapy / Q000706:statistics & numerical data; D063868:Patient Outcome Assessment; D010359:Patient Readmission; D011183:Postoperative Complications; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000601:surgery*; D014068:Tonsillectomy
chemical_list: D010100:Oxygen