Complicaciones postoperatorias tras adenoamigdalectomía en 2 grupos de pacientes pediátricos: síndrome de apnea-hipopnea del sueño e infecciones de repetición

Rodríguez-Catalán, Jesús; Padial, J Fernández-Cantalejo; Rodríguez, Paula; Galán, Fernando González; Camacho, Genoveva del Río

doi:10.1016/j.otorri.2019.01.002

Cited by 3 publications

(4 citation statements)

References 10 publications

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“…With the inclusion of five studies 15,17–19,24 that supplied precise information about the severity of OSA, the PoRCs rate was analyzed in each OSA severity subgroup and compared individually to non‐OSA patients. Based on the analysis, no significant difference was found in the case of mild OSA ( p = 0.619, OR: 1.15, 95% CI [0.651, 2.058]), but a significantly higher probability of PoRCs was observed in moderate ( p = 0.048, OR: 1.79, 95% CI [1.004, 3.194]) and severe OSA ( p = 0.002, OR: 4.06, 95% CI [1.68, 9.81]) compared to non‐OSA patients.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 19 studies were included in this meta-analysis, examining PoRCs following AT surgery in 120,544 patients, with 59,323 of them involving OSA. Thirteen of the included studies were retrospective observational (Allareddy et al, 14 Camacho et al, 15 Castano et al, 16 Dalesio et al, 17 Ekstein et al, 18 Kang et al, 19 Kieran et al, 20 Lalakea et al, 21 Marsollier et al, 22 Patel et al, 23 Rodriguez-Catalán et al, 24 Tweedie et al, 25 and Ali et al), 26 two retrospective case-control (Gehrke et al 27 and Riaz et al), 28 one ambidirectional (Muninnobpamasa et al), 29 one prospective (Sanders et al) 30 and two cross-sectional (Kou et al 31 and Martins et al). 32 The number of patients examined in the various studies included were as follows: four of the studies 23,28,30,32 had fewer than 100 patients participating, another four 16,18,21,22 consisted of 100-200, five studies 15,17,24,26,29 comprised 200-500, two 19,20 involved 500-1000, and four 14,25,27,31 had over 1000.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…PoRCs in pediatric patients following AT surgery shows higher occurrence in OSA than in non-OSA Based on our analysis of all 19 included studies, [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] PoRCs following AT surgery show a significantly higher occurrence rate in children with OSA (OR: 2.24, 95% CI [1.60, 3.15], p < 0.001). However, it must be noted that the statistical heterogeneity was high (I 2 65.4%, χ 2 test p < 0.001), most likely due to a case-control study with significantly different results.…”

Section: Primary Outcomesmentioning

confidence: 99%

“…15,[17][18][19]24 that supplied precise information about the severity of OSA, the PoRCs rate was analyzed in…”

mentioning

confidence: 99%

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The risk of postoperative respiratory complications following adenotonsillar surgery in children with or without obstructive sleep apnea: A systematic review and meta‐analysis

Keserű

Sipos

Farkas

et al. 2022

Pediatric Pulmonology

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Objectives Obstructive sleep apnea (OSA) appears in 2%–5% of children, with first‐line treatment being adenotonsillar (AT) surgery. Our aim was to examine the risk of postoperative respiratory complications (PoRCs) in non‐OSA and the different OSA severity (mild, moderate, severe) groups. Study Design We conducted a systematic review and meta‐analysis of studies comparing PoRCs following AT surgery in children with and without OSA. Methods Nineteen observational studies were identified with the same search key used in MEDLINE, Embase, and CENTRAL. The connection between PoRCs, the presence and severity of OSA, and additional comorbidities were examined. Odds ratios (OR) were calculated with 95% confidence intervals (CI). Results We found that PoRCs appeared more frequently in moderate (p = 0.048, OR: 1.79, CI [1.004, 3.194]) and severe OSA (p = 0.002, OR: 4.06, CI [1.68, 9.81]) compared to non‐OSA patients. No significant difference was detected in the appearance of major complications (p = 0.200, OR: 2.14, CI [0.67, 6.86]) comparing OSA and non‐OSA populations. No significant difference was observed in comorbidities (p = 0.669, OR: 1.29, CI [0.40, 4.14]) or in the distribution of PoRCs (p = 0.904, OR: 0.94, CI [0.36, 2.45]) between the two groups. Conclusion Uniform guidelines and a revision of postoperative monitoring are called for as children with moderate and severe OSA are more likely to develop PoRCs following AT surgery based on our results, but no significant difference was found in mild OSA. Furthermore, the presence of OSA alone is not associated with an increased risk of developing major complications.

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Section: Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Primary Outcomesmentioning

confidence: 99%

“…15,[17][18][19]24 that supplied precise information about the severity of OSA, the PoRCs rate was analyzed in…”

mentioning

confidence: 99%

See 2 more Smart Citations

The risk of postoperative respiratory complications following adenotonsillar surgery in children with or without obstructive sleep apnea: A systematic review and meta‐analysis

Keserű

Sipos

Farkas

et al. 2022

Pediatric Pulmonology

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Does infection play a role in post-tonsillectomy haemorrhage? A narrative review

2022

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Objective Post-tonsillectomy haemorrhage is an increasingly common cause of morbidity following tonsillectomy. Secondary post-tonsillectomy haemorrhage occurring more than 24 hours after an operation has long been attributed to post-operative infection; however, there is little evidence to support this hypothesis and the associated use of antibiotics in the current literature. Method This study looked at the aetiology and evidence-based management of post-tonsillectomy haemorrhage, and investigated the impact of bacterial infection and antimicrobials on the pathogenesis and clinical course of this complication. Results A number of peri-operative risk factors for post-tonsillectomy haemorrhage exist, and infective pathologies, including recurrent or chronic tonsillitis and group A streptococcus on blood cultures, may predispose to bleeding. Very few studies have shown a link between post-tonsillectomy haemorrhage and objective markers of infection such as pyrexia, raised inflammatory markers or positive microbiology cultures. The role of antibiotics in secondary post-tonsillectomy haemorrhage remains controversial, and numerous randomised, controlled trials of peri-operative antibiotics have shown no significant difference in bleeding rates between antibiotics and controls. Conclusion Further trials investigating the role of antibiotics and more robust studies investigating the presence of bacterial infection at the time of bleeding may be required to determine the true role of infection in post-tonsillectomy haemorrhage.

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Modified dindo-clavien system for registration of perioperative complications in children undergoing adenotonsillectomy

et al. 2022

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IntroductionSurgical procedures in children are among the most commonly performed procedures in otolaryngology. Perioperative safety and documentation of complications are becoming increasingly important. This study investigates perioperative complications in a clinical cohort of children with adenotonsillar hyperplasia undergoing adenotonsillectomy using the standardized Dindo-Clavien reporting system.Patients and MethodsRetrospective evaluation of 402 children who underwent adenotonsillectomy between 2009 and 2015. Patient parameters including all perioperative complications were investigated.ResultsIn the study, 124 complications were found (106 mild, 16 severe). According to the Dindo-Clavien classification, 93 grade I, 15 grade II, 5 grade III, 11 grade IV and 0 grade V complications were documented. Complications were associated with additional diagnoses (p = 0.001), long-term medication intake (p = 0.003), duration of hospitalization (p < 0.001) and duration of surgery (p < 0.001), undergoing tonsillotomy (p = 0.022) or tonsillectomy (p < 0.001), differences in ASA score (p = 0.005) and differences in OSA-18 score (p = 0.011). Severe complications, classified as grade III and IV, were associated with premature birth (p = 0.026), additional diagnoses (p = 0.017), long-term medication intake (p < 0.001) and differences in ASA score (p =< 0.001).ConclusionThe Dindo-Clavien classification is a standardized reporting system which can also be used for surgical procedures in children with adenotonsillar hyperplasia. The system shows associations with clinical parameters and thus can help to identify subgroups at risk of severe complications.

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Complicaciones postoperatorias tras adenoamigdalectomía en 2 grupos de pacientes pediátricos: síndrome de apnea-hipopnea del sueño e infecciones de repetición

Cited by 3 publications

References 10 publications

The risk of postoperative respiratory complications following adenotonsillar surgery in children with or without obstructive sleep apnea: A systematic review and meta‐analysis

The risk of postoperative respiratory complications following adenotonsillar surgery in children with or without obstructive sleep apnea: A systematic review and meta‐analysis

Does infection play a role in post-tonsillectomy haemorrhage? A narrative review

Modified dindo-clavien system for registration of perioperative complications in children undergoing adenotonsillectomy

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