Indications, clinical course, and postoperative outcomes of urgent adenotonsillectomy in children

• Published in: JAMA otolaryngology-- head & neck surgery Vol. 141; no. 3; p. 236
• Main Authors: Liang, Conan, Ruiz, Amanda G, Jensen, Emily L, Friedman, Norman R
• Format: Journal Article
• Language: English
• Published: United States 01-03-2015
• Subjects: Adenoidectomy; Case-Control Studies; Child; Child, Preschool; Emergencies; Female; Humans; Hypoxia - etiology; Hypoxia - surgery; Infant; Male; Obesity - complications; Oxygen - blood; Oxygen Inhalation Therapy - statistics & numerical data; Patient Outcome Assessment; Patient Readmission; Postoperative Complications; Retrospective Studies; Severity of Illness Index; Sleep Apnea, Obstructive - complications; Sleep Apnea, Obstructive - surgery; Tonsillectomy
• ISSN: 2168-619X
• DOI: 10.1001/jamaoto.2014.3341

Children undergoing urgent adenotonsillectomy have been poorly described in literature.
To characterize the clinical course and outcomes of patients who underwent urgent adenotonsillectomy.
A 7-year retrospective medical record review of patients undergoing urgent adenotonsillectomy (study group) at a tertiary care pediatric hospital was undertaken. Comparisons were made between the study group and the control group consisting of children undergoing adenotonsillectomy following diagnostic polysomnography.
Retrospective medical record review with no study interventions.
Demographics, hospital course, and clinical outcomes.
A total of 35 patients (21 boys [60%] and 14 girls [40%]; mean age, 3.8 years) were identified as having undergone urgent adenotonsillectomy defined as severe obstructive sleep apnea with associated hypoxemia unresponsive to oxygen. The control group included 301 patients who received a diagnostic polysomnogram prior to nonurgent adenotonsillectomy. Patients undergoing urgent adenotonsillectomy patients were more likely to be younger than 3 years (54%) than nonurgent patients (P < .001) and were characterized by elevated obstructive apnea-hypopnea indices (average, 39.4 events per hour). Persistent desaturation below 80% despite at least 0.5 L of supplemental oxygen was the most common admission indication (83%). Obesity was the most frequent comorbidity (9 patients [31%]). Two patients (6%) experienced a major postoperative complication requiring intervention. Fifteen patients (43%) were discharged with supplemental oxygen. Two patients (6%) were admitted to the hospital more than 72 hours after surgery.
Patients requiring urgent adenotonsillectomy are marked by younger age, elevated obstructive apnea-hypopnea indices, and persistent desaturations below 80% unresponsive to supplemental oxygen. Following surgery, some children have a dramatic improvement in gas exchange and will no longer require supplemental oxygen.