title: Risk factors for respiratory complications after adenotonsillectomy in children with obstructive sleep apnea.
abstract: OBJECTIVE
  To identify risk factors for respiratory complications after adenotonsillectomy in children ≤ 12 years of age with obstructive sleep apnea who were referred to the pediatric ICU (PICU).
  
  
  METHODS
  A cross-sectional historical cohort study analyzing 53 children after adenotonsillectomy who met predetermined criteria for PICU referral in a tertiary level teaching hospital. The Student's t-test, Mann-Whitney test, and chi-square test were used to identify risk factors.
  
  
  RESULTS
  Of the 805 children undergoing adenotonsillectomy between January of 2006 and December of 2012 in the teaching hospital, 53 were referred to the PICU. Twenty-one children (2.6% of all those undergoing adenotonsillectomy and 39.6% of those who were referred to the PICU) had respiratory complications. Of those 21, 12 were male. The mean age was 5.3 ± 2.6 years. A high apnea-hypopnea index (AHI; p = 0.0269), a high oxygen desaturation index (ODI; p = 0.0082), a low SpO2 nadir (p = 0.0055), prolonged orotracheal intubation (p = 0.0011), and rhinitis (p = 0.0426) were found to be independent predictors of respiratory complications. Some of the complications observed were minor (SpO2 90-80%), whereas others were major (SpO2 ≤ 80%, laryngospasm, bronchospasm, acute pulmonary edema, pneumonia, and apnea).
  
  
  CONCLUSIONS
  Among children up to 12 years of age with OSA, those who have a high AHI, a high ODI, a low SpO2 nadir, or rhinitis are more likely to develop respiratory complications after adenotonsillectomy than are those without such characteristics.
authors.affiliation: School of Medicine, São Paulo State University Botucatu, Botucatu, Brazil.
authors.forename: Renato Oliveira
authors.initials: RO
authors.lastname: Martins
authors.affiliation: School of Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Nuria
authors.initials: N
authors.lastname: Castello-Branco
authors.affiliation: Botucatu School of Medicine, São Paulo State University, Botucatu, Brazil.
authors.forename: Jefferson Luis de
authors.initials: JL
authors.lastname: Barros
authors.affiliation: Botucatu School of Medicine, São Paulo State University, Botucatu, Brazil.
authors.forename: Silke Anna Theresa
authors.initials: SA
authors.lastname: Weber
mesh_terms: D000233:Adenoidectomy / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D017286:Polysomnography; D011183:Postoperative Complications; D012120:Respiration Disorders / Q000145:classification / Q000209:etiology*; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D014068:Tonsillectomy / Q000009:adverse effects*