title: Complications of adenotonsillectomy for obstructive sleep apnea in school-aged children.
abstract: BACKGROUND
  Adenotonsillectomy is the treatment of choice for most children with obstructive sleep apnea syndrome, but can lead to complications. Current guidelines recommend that high-risk children be hospitalized after adenotonsillectomy, but it is unclear which otherwise-healthy children will develop post-operative complications. We hypothesized that polysomnographic parameters would predict post-operative complications in children who participated in the Childhood AdenoTonsillectomy (CHAT) study.
  
  
  METHODS
  Children in the CHAT study aged 5-9 years with apnea hypopnea index 2-30/h or obstructive apnea index 1-20/h without comorbidities other than obesity/asthma underwent adenotonsillectomy. Associations between demographic variables and surgical complications were examined with Chi square and Fisher's exact tests. Polysomnographic parameters between subjects with/without complications were compared using Mann-Whitney tests.
  
  
  RESULTS
  Of the 221 children (median apnea hypopnea index 4.7/h, range 1.2-27.7/h; 31% obese), 16 (7%) children experienced complications. 3 (1.4%) children had respiratory complications including pulmonary edema, hypoxemia and bronchospasm. Thirteen (5.9%) had non-respiratory complications, including dehydration (4.5%), hemorrhage (2.3%) and fever (0.5%). There were no statistically significant associations between demographic parameters (gender, race, and obesity) or polysomnographic parameters (apnea hypopnea index, % total sleep time with SpO2<92%, SpO2 nadir, % sleep time with end-tidal CO2>50Torr) and complications.
  
  
  CONCLUSIONS
  This study showed a low risk of post-adenotonsillectomy complications in school-aged healthy children with obstructive apnea although many children met published criteria for admission due to obesity, or polysomnographic severity. In this specific population, none of the polysomnographic or demographic parameters predicted post-operative complications. Further research could identify the patients at greatest risk of post-operative complications.
authors.affiliation: Department of Pediatrics, Sleep Center, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: Konstantis@chop.edu.
authors.forename: Sofia
authors.initials: S
authors.lastname: Konstantinopoulou
authors.affiliation: Biostatistics Core, The Clinical and Translational Research Center, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States.
authors.forename: Paul
authors.initials: P
authors.lastname: Gallagher
authors.affiliation: Department of Otolaryngology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States.
authors.forename: Lisa
authors.initials: L
authors.lastname: Elden
authors.affiliation: Department of Otolaryngology, University of Michigan, Ann Arbor, MI, United States.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Garetz
authors.affiliation: Department of Otolaryngology, UT Southwestern Medical Center, Dallas, TX, United States; Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, United States.
authors.forename: Ron B
authors.initials: RB
authors.lastname: Mitchell
authors.affiliation: Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
authors.forename: Susan
authors.initials: S
authors.lastname: Redline
authors.affiliation: Department of Pediatrics, Rainbow Babies & Children's Hospital, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, United States.
authors.forename: Carol L
authors.initials: CL
authors.lastname: Rosen
authors.affiliation: Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
authors.forename: Eliot S
authors.initials: ES
authors.lastname: Katz
authors.affiliation: Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States; Department of Neurology, University of Michigan, Ann Arbor, MI, United States.
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Chervin
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
authors.forename: Raouf
authors.initials: R
authors.lastname: Amin
authors.affiliation: Department of Pediatrics, Children's Hospital at Montefiore and Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States.
authors.forename: Raanan
authors.initials: R
authors.lastname: Arens
authors.affiliation: Department of Pediatrics and Internal Medicine, Cardinal Glennon Children's Medical Center, Saint Louis University, St Louis, MO, United States.
authors.forename: Shalini
authors.initials: S
authors.lastname: Paruthi
authors.affiliation: Department of Pediatrics, Sleep Center, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States.
authors.forename: Carole L
authors.initials: CL
authors.lastname: Marcus
mesh_terms: D000233:Adenoidectomy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D017286:Polysomnography; D011183:Postoperative Complications; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D014068:Tonsillectomy
keywords: Adenotonsillectomy; Childhood AdenoTonsillectomy study; Obstructive sleep apnea syndrome; Polysomnography