Safety and efficacy of adenotonsillectomy for obstructive sleep apnea in infants, toddlers and preschool children.
OBJECTIVE
To investigate and compare the safety and efficacy of adenotonsillectomy (AT) on obstructive sleep apnea (OSA) in infants and toddlers (IT) with preschool children (PS), and charts of 147 children between the ages of 11 months and 6 years were reviewed.


METHODS
Harmonic Scalpel (HS) was introduced into AT to reduce the operative duration and intraoperative hemorrhage. Preoperative and postoperative apnea-hypopnea indices (AHI) values obtained by the type 3 portable monitoring device, and the change achieved by AT were statistically compared between IT group (N=50) and PS group (N=97). The mean operative duration, the mean amount of intraoperative hemorrhage, the incidence of postoperative hemorrhage, the frequency of abnormal postoperative chest X-ray findings, and the length of hospital stay were also compared between the two groups. All statistical analyses were conducted using either the Student's t test or Fischer's exact test, and p-values <0.05 were considered statistically significant.


RESULTS
In the IT group, the mean preoperative AHI value was 13.5±7.1 and decreased to 4.7±3.4 postoperatively. In the PS group, the mean AHI value changed from 16.0±10.2 to 4.4±2.4. There were statistically significant differences between the preoperative and postoperative AHI values in both the IT and PS groups, but there were no statistically significant differences between the IT and PS groups. The mean operative durations in the IT group for tonsillectomy and adenoidectomy were 12.8±6.7 min and 19.5±8.1 min, respectively. The corresponding values in the PS group were 14.5±6.6 min and 22.9±9.7 min, respectively. The mean tonsillectomy durations were comparable, but the adenoidectomy duration was statistically shorter in the IT group. In the IT group, the mean amounts of intraoperative hemorrhage during tonsillectomy and during adenoidectomy were 6.0±5.1 and 18.9±10.6 g, respectively. The corresponding values in the PS group were 6.4±5.4 g and 26.2±13.4 g, respectively. The mean tonsillectomy blood loss was comparable between the groups but was statistically less during adenoidectomy in the IT group. There were no statistical differences between the two groups in the incidence of postoperative hemorrhage and of abnormal findings in the postoperative chest X-ray, and in the length of hospital stay.


CONCLUSIONS
AT in IT can be performed without major perioperative complications and should be considered the primary treatment of OSA from infancy to early childhood. Ultrasonic devices may contribute to increasing the safety of this surgical treatment.
Department of Otolaryngology, Tokai University, School of Medicine, Japan; Formerly Department of Otolaryngology, Kochi Medical School, Japan. Electronic address: mhamada@is.icc.u-tokai.ac.jp.
Masashi
M
Hamada
Department of Otolaryngology, Tokai University, School of Medicine, Japan.
Masahiro
M
Iida
Department of Otolaryngology, Ehime University, School of Medicine, Japan; Formerly Department of Otolaryngology, Kochi Medical School, Japan.
Jumpei
J
Nota
Formerly Department of Otolaryngology, Kochi Medical School, Japan.
Noboru
N
Matsumoto
Formerly Department of Otolaryngology, Kochi Medical School, Japan.
Shoichi
S
Sawada
Formerly Department of Otolaryngology, Kochi Medical School, Japan.
Naoko
N
Mukushita
Formerly Department of Otolaryngology, Kochi Medical School, Japan.
Yozo
Y
Washizu
Clinical and Sleep Laboratory, Kochi Medical School Hospital, Japan.
Mutsumi
M
Shimasaki
Clinical and Sleep Laboratory, Kochi Medical School Hospital, Japan.
Tadafumi
T
Doi
D000233:Adenoidectomy / Q000379:methods*; D016063:Blood Loss, Surgical; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D061646:Operative Time; D019106:Postoperative Hemorrhage; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D014068:Tonsillectomy / Q000379:methods*; D016896:Treatment Outcome
Apnea–hypopnea index; Clinical pathway; Harmonic Scalpel; Portable monitoring device; Postoperative complication