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

McCormick, Michael E.; Sheyn, Anthony; Haupert, Michael; Folbe, Adam J.

doi:10.1016/j.ijporl.2013.07.012

Cited by 10 publications

(9 citation statements)

References 23 publications

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“…T he combination of tonsillectomy and adenoidectomy (T&A) is one of the most frequently performed procedures in children, with more than 500 000 operations each year in the United States. [1][2][3][4] Given that obstructive sleep apnea (OSA) is one of the most common indications for this surgery, identification of those patients who may be at high risk for postoperative oxygen desaturation and other airway-related complications is important. 1,2,[5][6][7][8] This need has become especially relevant because the surgery increasingly has been performed in an outpatient setting.…”

mentioning

confidence: 99%

Postoperative Complications in Pediatric Tonsillectomy and Adenoidectomy in Ambulatory vs Inpatient Settings

Amoils

Chang

Saynina

et al. 2016

JAMA Otolaryngol Head Neck Surg

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confidence: 99%

Postoperative Complications in Pediatric Tonsillectomy and Adenoidectomy in Ambulatory vs Inpatient Settings

Amoils

Chang

Saynina

et al. 2016

JAMA Otolaryngol Head Neck Surg

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“…All children with complications had sleep-disordered breathing and all but one had concomitant risk factors for complications after tonsillectomy. 13 The development of aspiration pneumonitis, hypoxemia, and need for oxygen support were significantly higher among children with reflux. These events could impact postoperative monitoring strategies and provide a rationale for clinicians to screen children for GER prior to tonsillectomy.…”

Section: Discussionmentioning

confidence: 95%

“…10 A growing amount of evidence has correlated poorer post-tonsillectomy outcomes among children diagnosed with reflux. Specifically, reflux has been shown to predict worse pain and more frequent bleeding, 11 early airway complications, 12,13 and increased length of hospitalization. 12,14 However, these studies have been limited by the lack of prospective design and small sample size precluding a robust analysis of rare post-tonsillectomy events.…”

Section: Introductionmentioning

confidence: 99%

Reflux as a Risk Factor for Morbidity after Pediatric Tonsillectomy: A National Cohort of Inpatients

2020

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Objective: Gastroesophageal reflux (GER) has been identified as a risk factor for complications following pediatric tonsillectomy. The primary objective of this study was to examine outcomes after tonsillectomy among children with GER using a nationwide database. Secondary objectives included analyzing duration of hospitalization and total charges after admission. Methods: A cross-sectional review of the Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Databases (KID) from 2012 and 2016. Results: A total of 21,232 children had a tonsillectomy with or without adenoidectomy, with 1683 (7.9%) diagnosed with GER. Average age for patients with reflux was 4.4 years and for those without was 5.6 years (P < .001). The rate of primary hemorrhage was not statistically different between groups (P = .87). Patients with reflux were more likely to have respiratory complications (P = .03), aspiration pneumonitis (P < .001), and hypoxemia (P < .001) during their hospital course. Noninvasive ventilation and reintubation also occurred more frequently in this population (P < .001). Children with reflux had a longer duration of postoperative admission (3.8 vs. 2.3 days, P < .001) and higher total hospital charges ($47,129 vs. $27,584, P < .001). Multivariable regression analysis determined that reflux remained a statistically significant indicator of aspiration pneumonitis, hypoxemia, invasive and non-invasive ventilation, as well as length of admission. Conclusion: Children with GER were significantly more likely to experience inpatient complications following tonsillectomy. Further, length of admission was higher compared to children without reflux. These results suggest that children with GER experience poorer outcomes after tonsillectomy and highlight the role for appropriate preoperative counseling and planning in this patient population.

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“…The clinical spectrum of LPR varies from cough to apnea [20]. LPR has been implicated in the etiology of several common otolaryngological disorders, including adenotonsillar hyperplasia, OSA, chronic rhinitis, sinusitis, laryngeal disorders, and otitis media with effusion in [15] reported that gastroesophageal reflux was a risk factor in children aged 1-2 for early complications following adenotonsillectomy. The present prospective study was performed to evaluate complications following adenotonsillectomy in children with and without LPR.…”

Section: Discussionmentioning

confidence: 99%

“…Several factors, such as younger age, OSA, craniofacial anomalies, prematurity, Down's syndrome, cerebral palsy, cardiovascular disease, obesity, and bleeding disorders, increase the complication rate following tonsillectomy [11][12][13][14]. Gastroesophageal reflux has also been identified as a risk factor for complications in tonsillectomy in recent studies [15,16].…”

Section: Introductionmentioning

confidence: 99%

Role of Laryngopharyngeal Reflux in Complications of Tonsillectomy in Pediatric Patients

Saltürk

Kumral

Arslanoğlu

et al. 2015

Indian J Otolaryngol Head Neck Surg

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Tonsillectomy and tonsillectomy with adenoidectomy are among the most common surgical procedures in otolaryngology practice. Gastroesophageal reflux was identified as a risk factor for complications in tonsillectomy. This prospective study was designed to assess the role of reflux in the development of complications following tonsillectomy in pediatric patients. Children (n = 60) who underwent tonsillectomy with adenoidectomy were divided into two groups, i.e., the laryngopharyngeal reflux (LPR) group and control group. Patients with LPR were identified by reflux symptom index and reflux finding score. Pain, hemorrhage, fever, nausea, vomiting, fever, dehydration, infection, and pulmonary problems were evaluated post operatively. The mean lengths of hospital stay were 2.11 days in the reflux group and 1.05 days in the control group. The difference was statistically significant. Visual analogue scores of both groups were similar on day 1 but it was significantly higher on day 7 and 14 in LPR group. Nausea and vomiting rates were 11.1 and 9.5 % for the patients in the LPR group and the controls, respectively. The difference between the two groups was not significant. The mean fever was 37.6 °C in the reflux group and 37.3 °C in the controls, which were not significantly different. 19 % of the controls and 22 % of the LPR group patients were readmitted. This difference was not statistically significant. There were two cases of bleeding in the reflux group, while no bleeding occurred in the control group. This difference was significant statistically. LPR is a risk factor for complications following tonsillectomy.

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

Cited by 10 publications

References 23 publications

Postoperative Complications in Pediatric Tonsillectomy and Adenoidectomy in Ambulatory vs Inpatient Settings

Postoperative Complications in Pediatric Tonsillectomy and Adenoidectomy in Ambulatory vs Inpatient Settings

Reflux as a Risk Factor for Morbidity after Pediatric Tonsillectomy: A National Cohort of Inpatients

Role of Laryngopharyngeal Reflux in Complications of Tonsillectomy in Pediatric Patients

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