A pilot study to identify pre- and peri-operative risk factors for airway complications following adenotonsillectomy for treatment of severe pediatric OSA

Clinical Prediction Rules, Adenotonsillectomy and Children With Obstructive Sleep Apnea: What's Next?

“…Studies in children have reported "very" severe OSA (AHI > 20) in isolation as not being predictive of PRCs, suggesting it is some combination of age, ill-defined comorbidities including obesity, ethnicity, and other unknown factors that modulate the risk and predispose the child to complications at a lower AHI threshold. [15][16][17][18][19][20] Obesity was not included in Smith et al's final prediction rule, suggesting in isolation it is a non-risk factor, which has also been supported by recent literature. 20 The degree of nocturnal hypoxemic burden measured as clusters of oxygen desaturation, total sleep time < 90% saturation, or as an oxygen desaturation index are increasingly being adopted to predict the presence and severity of OSA and risk for a PRC following AT.…”

Variation in Inpatient Tonsillectomy Costs Within and Between US Hospitals Attributable to Postoperative Complications

“…It is still unclear what care settings would be optimal for severe respiratory complications, with or without mechanical ventilation, given increasingly constricted hospital resources. For example, Hill et al 37 have suggested that carefully selected tonsillectomy patients with respiratory complications could reasonably be managed in a step-down or ward unit rather than in an ICU, saving costs while maintaining good outcomes. Such a shift in the care setting would be highly dependent not only on clinical judgment but also on local resources and staffing, such as the availability of continuous oximetry, respiratory therapists, and advanced nursing.…”

Gastroesophageal reflux as a predictor of complications after adenotonsillectomy in young children

“…The currently known risk factors for post-operative complications following adenotonsillectomy include: bleeding disorders, severe obstructive sleep apnea, craniofacial syndromes, major cardiac disease, and age less than 3 years old [1,[3][4][5][8][9][10]16]. We recently identified gastroesophageal reflux (GER) as an independent risk factor for early complications in children 3 years old and younger [11].…”