title: Clinical outcomes in a high nursing ratio ward setting for children with obstructive sleep apnea at high risk after adenotonsillectomy.
abstract: BACKGROUND
  In 2012 clinical management of children having adenotonsillectomy (AT) for suspected obstructive sleep apnea (OSA) at our tertiary centre changed based on previous research: children with severe obstructive sleep apnea (OSA) at increased risk of post-operative respiratory adverse events (AE) identified using home overnight oximetry or polysomnography (PSG) were managed post-operatively in a high nurse/patient ratio unit in the ward (high acuity unit, HAU) rather than in the intensive care unit (ICU) as previously.
  
  
  OBJECTIVE
  To examine the post-operative respiratory AE post AT in HAU.
  
  
  METHODS
  A retrospective audit was performed of children having AT on the HAU list from Oct 2012-Sept 2014, identifying clinical information, pre-operative testing for OSA and post-operative course.
  
  
  RESULTS
  343 children underwent elective adenotonsillectomy at our tertiary centre in the study period, of whom 79 had surgery on the HAU list (16F; median age 4.2year (range 1.2-14.7); median weight-for-age centile 77.9% (IQR 44-98.7%)). 75 had moderate/severe OSA by oximetry (n=44) or PSG (n=31) criteria. 77 of 79 children had oxygen therapy in the recovery room (median 20min, IQR 15-40min). 18 (23%) had at least one AE outside the recovery room, which were observed (n=2) or treated with oxygen therapy (n=14) or repositioning (n=2). Obesity increased the risk of an AE (10/25 obese vs 8/54 non obese, p=0.01), as did the presence of a major comorbidity (5/9 with comorbidity vs 13/70 without, p=0.03). There were no admissions from the HAU to ICU. 63 patients (83%) stayed only one night in hospital (median 1d, range 1-5d).
  
  
  CONCLUSIONS
  In a cohort of children with known moderate-severe OSA, post-operative AE after AT were all managed in the HAU. Post-operative care in HAU provides safe and effective care for high-risk children post-AT, minimizing admissions to ICU.
authors: Melbourne Children's Sleep Centre, Monash Children's Hospital, Monash Medical Centre, Melbourne, Australia.
authors: Sarah
authors: S
authors: Arachchi
authors: Melbourne Children's Sleep Centre, Monash Children's Hospital, Monash Medical Centre, Melbourne, Australia; Department of Paediatrics, Monash University, Melbourne, Australia.
authors: David S
authors: DS
authors: Armstrong
authors: Department of Anaesthesia, Monash Health, Melbourne, Australia.
authors: Noel
authors: N
authors: Roberts
authors: Department of Otolaryngology Head and Neck Surgery, Monash Health, Melbourne, Australia.
authors: Malcolm
authors: M
authors: Baxter
authors: Department of Otolaryngology Head and Neck Surgery, Monash Health, Melbourne, Australia.
authors: Sarah
authors: S
authors: McLeod
authors: Melbourne Children's Sleep Centre, Monash Children's Hospital, Monash Medical Centre, Melbourne, Australia; The Ritchie Centre, The Hudson Institute of Medical Research, Monash University, Melbourne, Australia.
authors: Margot J
authors: MJ
authors: Davey
authors: Melbourne Children's Sleep Centre, Monash Children's Hospital, Monash Medical Centre, Melbourne, Australia; Department of Paediatrics, Monash University, Melbourne, Australia; The Ritchie Centre, The Hudson Institute of Medical Research, Monash University, Melbourne, Australia. Electronic address: gillian.nixon@monashhealth.org.
authors: Gillian M
authors: GM
authors: Nixon
mesh_terms: D000233:Adenoidectomy; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D054869:Clinical Audit; D015897:Comorbidity; D005260:Female; D006757:Hospital Units; D006801:Humans; D007223:Infant; D008297:Male; D009741:Nursing Staff, Hospital; D009765:Obesity / Q000150:complications; D010092:Oximetry; D010102:Oxygen Inhalation Therapy; D011182:Postoperative Care / Q000451:nursing*; D011997:Recovery Room; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000451:nursing* / Q000601:surgery*; D014068:Tonsillectomy
keywords: Child; Complications; Obstructive sleep apnea; Tonsillectomy