title: Tonsillectomies and respiratory complications in children: A look at pre-op polysomnography risk factors and post-op admissions.
abstract: OBJECTIVE
  To identify predictors of post-operative respiratory complications in children undergoing tonsillectomy.
  
  
  METHODS
  Consecutive case series with chart review of children who underwent polysomnography (PSG) and subsequent tonsillectomy with or without adenoidectomy for obstructive sleep apnea (OSA). Patients with craniofacial anomalies or significant cardiopulmonary comorbidities were excluded. Rates of post-surgical respiratory complication were reviewed and compared to patient specific factors and PSG findings to identify possible risk factors.
  
  
  RESULTS
  Eighty-six patients (mean age 5.3 ± 2.2 years) were included. There was a statistically significant (p = 0.03) relationship between an AHI ≥40 (AHI40) and post-operative respiratory complications. AHI40 also had the greatest magnitude of association with postoperative respiratory complications (OR = 5.313). An AHI ≥25 (AHI25) was marginally significant (p = 0.067). No significant difference in outcome occurrence was found when analyzing rates of complication in patients with BMI above and below 18 (p = 0.20) or oxygen (O2) nadir above and below 80% (p = 0.09). The AHI ranged from 0 to 112.2, and no postoperative respiratory complications were identified in children with an AHI less than 10.
  
  
  CONCLUSIONS
  Our results indicate an association between an AHI ≥40 and respiratory complications following an adenotonsillectomy, but we were not able to observe any significant difference at a cutoff of 25. An association between BMI or O2 nadir and postoperative respiratory complication was not able to be identified. Our results support the importance of AHI as a predictor of postoperative respiratory complications in children undergoing tonsillectomy for OSA.
authors: Albert Einstein College of Medicine, Bronx, NY, USA.
authors: David
authors: D
authors: Kasle
authors: University of Colorado, Pediatric Otolaryngology Fellow, Denver, CO, USA.
authors: Jordan
authors: J
authors: Virbalas
authors: Albert Einstein College of Medicine, Bronx, NY, USA; Otolaryngology - Head and Neck Surgery, Montefiore Medical Center, Bronx, NY, USA.
authors: John P
authors: JP
authors: Bent
authors: Pediatric Otolaryngology, Department of Surgery, Division of Otolaryngology - Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, NC, USA. Electronic address: jeffrey.cheng@duke.edu.
authors: Jeffrey
authors: J
authors: Cheng
mesh_terms: D000233:Adenoidectomy / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D017286:Polysomnography; D011183:Postoperative Complications / Q000209:etiology*; D012120:Respiration Disorders / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D014068:Tonsillectomy / Q000009:adverse effects*
keywords: AHI; Adenotonsillectomy; Complications; Hospital admission; Risk factors