Author(s)
Kathleen R. Billings, MD1
Shaan N. Somani, BA2
Jennifer Lavin, MD1
Bharat Bhushan, PhD1
Affiliation(s)
1Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hosp. of Chicago, Chicago, IL, 2Feinberg School of Medicine, Northwestern Univ., Chicago, IL.;
Abstract:
Introduction: To analyze if certain preoperative polysomnogram (PSG) variables were associated with an increased incidence of postoperative respiratory complications in children < 3 years of age undergoing adenotonsillectomy (T&A) for the management of obstructive sleep apnea (OSA).
Methods: Historical cohort study of children <3 years of age who underwent T&A for the management of OSA at a tertiary care children's hospital from 1/1/08-6/1/2018. Postoperative hospital courses were analyzed to determine if certain clinical and PSG variables might have predicted an increased rate of respiratory complications.
Results: A total of 195 children <3 years of age underwent T&A for PSG confirmed OSA, with a mean age of 25.8 months (range 9-35 months). Thirty-five (17.9%) patients had moderate, and 141 (72.3%) had severe OSA. Most patients (n=160, 82.1%) required no respiratory interventions postoperatively. Those with severe OSA were more likely to require oxygen support (n=22, 15.6%) when compared to those with mild-moderate OSA (n=2, 4.5%). Patients admitted directly to the pediatric intensive care unit (PICU) from the sleep lab (n=7) had a mean AHI of 63.6 (range 23-146), and a mean low O2 nadir of 56.3% (range 46-68). Four of these patients required CPAP after T&A, and the patient with the AHI of 146 required reintubation in the operating room for respiratory distress. Of the 7 patients (3.6%) who required intubation after their procedure, only 1 did not have severe OSA, and 2 were intubated to manage post-obstructive pulmonary edema. Only 4 patients (4.2%) had unplanned PICU admissions.
Conclusion: Most children < 3 years of age, even with severe OSA, had no respiratory issues postoperatively. Those with severe OSA and hypoxemia admitted directly from the sleep lab were more likely to require CPAP postoperatively. All but one patient who developed POPE or who required intubation had severe OSA with associated hypoxemia on their preoperative PSGs.