Impacts of disease severity on postoperative complications in children with sleep-disordered breathing
Journal
Laryngoscope
Journal Volume
127
Journal Issue
11
Pages
2646-2652
Date Issued
2017
Author(s)
Abstract
Objectives/Hypothesis: To investigate the effects of diseases severity on postoperative complications following adenotonsillectomy (T&A) in children with sleep-disordered breathing (SDB). Study Design: Retrospective study. Methods: Children aged <18 years were enrolled and underwent T&A for treating SDB. Polysomnography was used to classify the disease severity: primary snoring (apnea-hypopnea index [AHI] <1), mild (AHI = 1–5), moderate (AHI = 5–10), and severe obstructive sleep apnea [OSA] (AHI ?10). Postoperative bleeding was graded using a severity scale (level I, self-reported bleeding; level II, requiring inpatient admission; level III, requiring reoperation). Primary bleeding is defined as hemorrhage occurring within the initial 24 postoperative hours. Perioperative respiratory complications are defined as oxygen saturation of less than 90%, 92%, or 95% in the recovery room. Major respiratory complications include laryngospasm, pulmonary edema, pneumonia, and intubation at recovery stage. Results: A total of 610 children were included, of whom 42 (6.9%), eight (1.3%), and six (1.0%) children showed levels I, II, and III postoperative bleeding, respectively. Only one child had primary bleeding. The incidence and timing of postoperative bleeding did not differ significantly for children with different OSA severities. The rate of perioperative respiratory complications ranged from 1.6% to 14.3% on the basis of their definitions. The Cochran-Armitage test supported the trend that perioperative respiratory complications increase with the AHI. Six children developed major respiratory complications, which were not significantly associated with OSA severity. Conclusions: Children with severe OSA have increased risks of perioperative respiratory complications. However, OSA severity does not influence major respiratory complications or postoperative bleeding in children. Level of Evidence: 4. Laryngoscope, 127:2646–2652, 2017. ? 2017 The American Laryngological, Rhinological and Otological Society, Inc.
SDGs
Other Subjects
adenotonsillectomy; apnea hypopnea index; Article; bronchospasm; child; controlled study; disease association; disease severity; endotracheal intubation; female; human; incidence; larynx spasm; lung edema; major clinical study; male; oxygen saturation; pneumonia; polysomnography; postoperative complication; postoperative hemorrhage; prevalence; priority journal; respiration control; retrospective study; school child; sleep disordered breathing; adenoidectomy; adolescent; blood; pathophysiology; Postoperative Complications; postoperative hemorrhage; preschool child; Respiratory Tract Diseases; severity of illness index; Sleep Apnea Syndromes; Taiwan; tonsillectomy; oxygen; Adenoidectomy; Adolescent; Child; Child, Preschool; Female; Humans; Incidence; Male; Oxygen; Polysomnography; Postoperative Complications; Postoperative Hemorrhage; Respiratory Tract Diseases; Retrospective Studies; Severity of Illness Index; Sleep Apnea Syndromes; Taiwan; Tonsillectomy
Publisher
John Wiley and Sons Inc.
Type
journal article