Sleep Evaluation May Predict Risk for Complications after Tonsil Surgery

Performing polysomnography prior to pediatric adenotonsillectomy may help identify children at a higher risk of developing postoperative respiratory complications, according to a report in the Archives of Otolaryngology—Head & Neck Surgery.

Although pediatric adenotonsillectomy has been deemed a safe procedure, “there is a subset of patients who do not meet the criteria for outpatient surgery," according to the study. Guidelines for adenotonsillectomy, established by the American Academy of Otolaryngology—Head and Neck Surgery, recommend that children should be healthy, have no evidence of obstructive sleep apnea-hypopnea syndrome (recurring episodes of obstruction or collapse of the upper airway during sleep) and be older than age three.

To determine if polysomnography may potentially predict adverse outcomes following a pediatric adenotonsillectomy, Eric M. Jaryszak, MD, of the George Washington University School of Medicine and colleagues examined the records of 1,131 children who underwent an adenotonsillectomy by two attending surgeons at an academic pediatric hospital.

Preoperative polysomnography was performed on 151 patients, representing 13.4% of all those undergoing adenotonsillectomy. Of these, 23 (15.2%) experienced adverse respiratory events after surgery. Results of the polysomnography showed that patients who experienced respiratory complications had significantly higher apnea-hypopnea index, higher hypopnea index (episodes of overly shallow breathing or abnormally low respiratory rates) and lower nadir oxygen saturation (the lowest level of oxygen saturation).

Additionally, the 23 individuals who experienced complications had a higher body mass index compared with those who did not have complications, with 47.8% defined as obese, according to BMI criteria, versus 29.7% in the non-complication subgroup.

Overall, the patients who experienced adverse respiratory events spent an additional 22 days in the hospital beyond routine overnight observation for persons with obstructive sleep apnea-hypopnea syndrome.

"Polysomnographic data may potentially be used for predicting which patients are at higher risk for adverse respiratory events after adenotonsillectomy," the authors concluded. "Such knowledge is valuable in planning postoperative management and perhaps intraoperative anesthesia management. Predictors of increased respiratory complications include apnea-hypopnea index, hypopnea index, body mass index, and nadir oxygen saturation.”

To read the Archives of Otolaryngology—Head & Neck Surgery study, click here.