Author(s)
Ravi N. Patel, BA
Neha A. Patel, MD
Guillaume J. Stoffels, MA MS
Joshua B. Silverman, MD PhD
Lee P. Smith, MD
Affiliation(s)
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell;
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to demonstrate an understanding of common complications after adenoidectomies, major comorbidities that affect postoperative intervention rates and the reasoning behind the guidelines suggested in the study. Objectives: Current practices for admission for overnight observation after an adenoidectomy alone vary from hospital to hospital, as there are currently no studies that provide evidence for overnight observation criteria. The objective of this study is to determine any relationships between risk factors and postoperative complications or interventions in patients under 2 years old who undergo adenoidectomy and use this data to form a set of guidelines that may be used to stratify patients for inpatient observation. Study Design: Consecutive pediatric adenoidectomy without tonsillectomy cases in children younger than 2 years old with subsequent inpatient observation from January 2014 to October 2018 were reviewed at a single tertiary children's institution using electronic medical records. Methods: Patient demographics, surgical data, and comorbidities were analyzed for correlations with postoperative complications or interventions. Results: Out of the 76 patients with sleep disordered breathing (SDB) examined, one patient (1.3%) required readmission for postoperative dehydration and seven patients (9.2%) required intervention. The presence of at least one major comorbidity was significantly associated with increased incidence of complication or intervention compared to patients with no major comorbidities (18.9% vs. 2.6%, p=0.03). Specifically, O2 nadir <80% (p=0.01), craniofacial syndrome (p=0.01) and seizure history (p=0.007) were significant factors of complication or intervention. Conclusions: Otherwise healthy children (>18 month old) with SDB should be considered for discharge the same day of surgery. Children younger than 2 years old with one or more major comorbidities may benefit from overnight inpatient observation. Otherwise healthy children who are younger than 18 month old or children with a history of RAD or CLD should be managed on a case by case basis.