Postoperative respiratory complications and racial disparities following inpatient pediatric tonsillectomy: A cross‐sectional study

Kou, Yann‐Fuu; Sakai, Mark; Shah, Gopi; Mitchell, Ron B.; Johnson, Romaine F.

doi:10.1002/lary.27405

Cited by 48 publications

(56 citation statements)

References 33 publications

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“…Tonsillectomy is one of the most common procedures in pediatric patients and is a relatively safe procedure 1 ; however, it carries risk, in terms of airway complications with the rate of 2.4%. 2 Although children with risk factors are more likely to experience airway complications after tonsillectomy, 3 upper airway obstruction by the tongue or by uvular edema can occur and may lead to fatal complications even in healthy children without any risk factors.…”

Section: Introductionmentioning

confidence: 99%

Can Tonsillar Retractor–Induced Tongue Edema Be a New Complication in Pediatric Patients Undergoing Tonsillectomy Detected by Ultrasonography? A Prospective, Case-Controlled, Observational Study

et al. 2020

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Background: Tonsillectomy is one of the most common surgical procedures in pediatric patients. The tonsillar retractor, which is routinely used during a tonsillectomy, applies high pressure to the patient’s tongue and can lead to various complications. Aims: This study aimed to explore tongue edema induced by the pressure applied by tonsillar retractor, using ultrasonography in pediatric patients undergoing tonsillectomy surgeries. Materials and Methods: Sixty-one patients were included in the study. The tonsillectomy group included 31 patients who underwent tonsillectomy surgery, while the control group included 30 patients who underwent inguinal hernia and circumcision surgery. Submental coronal plane ultrasonography examinations of the tongue were performed twice for each patient. In the tonsillectomy group, the first examination of tongue area (TA1) was done immediately after intubation but before the placement of tonsillar retractor. The second examination (TA2) was done at the end of the tonsillectomy surgery after the removal of the tonsillar retractor but before extubation. In the control group, the first examination (TA1) was done immediately after intubation, whereas the second examination (TA2) was done at the end of the surgery before extubation. These results were compared with those for the control group. Results: Groups were similar in terms of demographics and intubation duration. Groups did not significantly differ in terms of TA1 ( P = .212), but they significantly differed in terms of TA2 ( P = .000). They also significantly differed in terms of tongue edema defined as TA2 − TA1 ( P = .000). Conclusions and Significance: Tonsillar retractor does cause tongue edema in tonsillectomy surgeries. This tongue edema seems to be a result of the pressure applied by the tonsillar retractor. This study is the first to demonstrate the possible role of ultrasonography examination in determining the tonsillar retractor–induced tongue edema in pediatric patients.

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Section: Introductionmentioning

confidence: 99%

Can Tonsillar Retractor–Induced Tongue Edema Be a New Complication in Pediatric Patients Undergoing Tonsillectomy Detected by Ultrasonography? A Prospective, Case-Controlled, Observational Study

et al. 2020

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“…There is also a growing body of literature that suggests that there may be a racial predilection to postoperative respiratory complications, with black children being at higher risk. 14,17 We are unable to assign causality due to the nature of this study, but there were significantly fewer white children and significantly more black and Hispanic children in the inpatient cohort. This again may reflect recognition of higher-risk populations or higher rates of other comorbidities, such as obesity or age \3 years.…”

Section: Discussionmentioning

confidence: 85%

A Cross‐sectional Analysis of Pediatric Ambulatory Tonsillectomy Surgery in the United States

Kou

Mitchell

Johnson

2019

Otolaryngol.--head neck surg.

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Objectives To report nationwide estimates of ambulatory tonsillectomies performed in hospitals and ambulatory surgery centers in the United States. Study Design Cross-sectional survey. Setting National databases. Subjects and Methods We analyzed the 2010 National Hospital Ambulatory Medical Care Survey of hospitals and ambulatory surgery centers for pediatric patients undergoing tonsillectomy with or without adenoidectomy. We determined estimations of the number of procedures, demographics, and outcomes. A tonsillectomy cohort from the 2009 National Inpatient Sample served as a comparison group. Results In 2010, there were an estimated 339,000 (95% CI, 288,000-391,000) ambulatory tonsillectomies in the United States. The mean age was 7.8 years (SD, 5.1), and 71,000 (21.0%) were <3 years old. The male:female ratio was even (51% vs 49%). The racial makeup mirrored the US census (69% white, 18% Hispanic, and 12% black). Obstructive sleep-disordered breathing was reported in 48%. Perioperative events such as apnea, hypoxia, or bleeding occurred 7.8% of the time. Approximately 9% of patients could not be discharged home. When compared with cases of inpatient tonsillectomies, ambulatory cases comprised older patients (7.8 vs 5.9 years, P < .001) and were less likely to include obstructive sleep-disordered breathing (48% vs 77%, P < .001). Conclusion Tonsillectomy was one of the most common ambulatory surgical procedures in 2010 in the United States. The majority of patients were low risk, but some at higher risk were included (age ≤3 years and obstructive sleep apnea). The National Hospital Ambulatory Medical Care Survey estimates provide useful baseline data for future research on quality measures and outcomes.

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“…Within the ENT surgical population, most studies on racial difference in surgical outcomes have been from single institutions and contained relatively small sample sizes of children undergoing predominantly adenotonsillectomy procedures 15 . In a recent large retrospective report, Kou et al examined 30 617 children undergoing inpatient adenotonsillectomy for either tonsillitis or OSA and found that black children experienced a 1.5 times higher risk than their white counterparts regarding the incidence of respiratory complications including pneumonia, postoperative pulmonary edema, postoperative tracheal intubation, and noninvasive and invasive mechanical ventilation 16 . This effect persisted after adjustment for gender, OSA, obesity, sickle cell anemia, and asthma.…”

Section: Discussionmentioning

confidence: 99%

Race and major pulmonary complications following inpatient pediatric otolaryngology surgery

Sivak

Mpody

Willer

et al. 2021

Pediatric Anesthesia

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Background: Compared to their white peers, black children are more likely to experience serious respiratory complications in the perioperative period. Whether a racial difference exists in the occurrence of late postoperative respiratory complications is largely unknown. Here, we evaluated a multi-institutional cohort of children who underwent various elective otolaryngology procedures to examine the racial differences in major postoperative pulmonary complications. Methods: We performed a retrospective analysis of elective inpatient otolaryngology cases from the National Surgical Quality Improvement Program (2012-2018). We used propensity score matching of black to white patients to compare the risk of postoperative pulmonary complications, defined as the occurrence of either pneumonia, unplanned reintubation, or prolonged postoperative mechanical ventilation. Results: The matched cohort was comprised of 4786 black and white patients (2 393 of each race). Black children were more likely to develop postoperative pulmonary complications compared to white peers (29.3% vs. 24.2%; odds ratio: 1.38; 95% confidence interval: 1.20, 1.59; P-value < .001). Furthermore, black children were almost two times more likely to require unplanned postoperative reintubation, relative to their white peers (2.6% vs. 1.3%; odds ratio: 2.07; 95% confidence interval: 1.33, 3.22; P-value < .001). Similarly, black children were estimated to have 37% relative greater odds of requiring prolonged mechanical ventilation (28.6% vs. 23.7%; 95% confidence interval: 1.19, 1.58; P-value < .001). Finally, being of black race conferred greater odds of requiring prolonged hospital length of stay, relative to being of white race (38.6% vs. 34.5%; odds ratio:1.24; 95% confidence interval: 1.09, 1.42; P-value = .004). Conclusion: Black children undergoing elective otolaryngological surgery are more likely to develop major postoperative pulmonary complications.

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Postoperative respiratory complications and racial disparities following inpatient pediatric tonsillectomy: A cross‐sectional study

Cited by 48 publications

References 33 publications

Can Tonsillar Retractor–Induced Tongue Edema Be a New Complication in Pediatric Patients Undergoing Tonsillectomy Detected by Ultrasonography? A Prospective, Case-Controlled, Observational Study

Can Tonsillar Retractor–Induced Tongue Edema Be a New Complication in Pediatric Patients Undergoing Tonsillectomy Detected by Ultrasonography? A Prospective, Case-Controlled, Observational Study

A Cross‐sectional Analysis of Pediatric Ambulatory Tonsillectomy Surgery in the United States

Race and major pulmonary complications following inpatient pediatric otolaryngology surgery

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