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

Int J Pediatr Otorhinolaryngol. 2011 Nov;75(11):1385-90. doi: 10.1016/j.ijporl.2011.07.034. Epub 2011 Aug 25.


Objective: A pilot study to identify risk factors predicting post-operative complications in children with severe OSA undergoing adenotonsillectomy.

Methods: Retrospective review in a tertiary care academic institution. Two-stage least squares regression analysis and instrumental variable analysis to allow for modeling of pre- and peri-operative risk factors as having significance in predicting post-operative morbidity.

Results: Eighty-three children (mean age 4.88 ± 3.09 years) with apnea-hypopnea index (AHI) ≥ 10 who were observed overnight following adenotonsillectomy were evaluated for rates of major (increased level of care, CPAP/BiPAP use, pulmonary edema and reintubation) and minor (oxygen saturation <90%) airway complications as well as total observation costs. Major and minor complications occurred in 4.8% and 19.3% of children, respectively. Age <2 years (p<0.01), AHI >24 (p<0.05), intra-operative laryngospasm requiring treatment (p<0.05), oxygen saturations <90% on room air in PACU (p<0.05) and PACU stay >100 min (p<0.01) independently predicted post-operative complications. Children with any one of these factors experienced a 38% complication rate versus 4% in all others.

Conclusions: This pilot study identified pre- and peri-operative risk factors that collectively can be investigated as predictors of post-operative airway complications in a prospective study. By identifying preliminary results comparing the complication rates between those children with and without these risk factors, we will be able to calculate the sample size for a future prospective validation study. Such a study is necessary to understand the safety and potential significant cost savings of observing children without risk factors on the pediatric floor and not in an ICU setting. A best practice algorithm can be created for children with severe OSA only after completing this prospective study.

Publication types

  • Comparative Study

MeSH terms

  • Academic Medical Centers
  • Adenoidectomy / adverse effects
  • Adenoidectomy / methods*
  • Age Factors
  • Child
  • Child, Preschool
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Patient Selection
  • Pilot Projects
  • Postoperative Care / methods*
  • Postoperative Complications / prevention & control*
  • Predictive Value of Tests
  • Preoperative Care / methods*
  • Recurrence
  • Regression Analysis
  • Retrospective Studies
  • Risk Assessment
  • Severity of Illness Index
  • Sleep Apnea, Obstructive / diagnosis
  • Sleep Apnea, Obstructive / surgery*
  • Time Factors
  • Tonsillectomy / adverse effects
  • Tonsillectomy / methods*
  • Treatment Outcome