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Inpatient Admissions after Aden Tonsillectomies for Pediatric Sleep-Disordered Breathing: Age as a Risk Factor

Mitali Doshi, BS, Syed Kamil, MD

Objectives: The aim of this study was to analyze the incidence of post-operative respiratory complications in children aged 0-18 who underwent tonsillectomy and required inpatient hospital admission to determine the necessity of inpatient management for children under 3 years of age as outlined in the AAO-HNS clinical guidelines.

Methods: This was a single center, retrospective chart review. Inclusion criteria were pediatric patients who underwent tonsillectomies over a 4-year time span that were ages 0-18 and required inpatient admission after surgery. Post-operative parameters collected included respiratory rate, heart rate, and oxygen saturations. Also examined were the complications of bleeding and dehydration. Chi-squared tests were performed to look for statistical significance with p<0.05 considered statistically significant.

Results: The study sample included 64 patients; and the mean age was 5.2 years old. The most common comorbidities included OSA, asthma, obesity, and anatomical abnormalities. Only five distinct patients had vital sign abnormalities such as tachycardia, tachypnea, and oxygen saturations <90%. Most of these patients had complex comorbidities which affected their post-operative course, including Trisomy 21, Noonan syndrome, macrocephaly, and laryngomalacia. The chi-squared test to determine the relationship between age group (age ≤3, age 4-11, age 12-18) and presence of complications revealed a p value of 0.90. This suggests that there is no statistically significant difference between the age groups in risk of having respiratory complications. There were no children under the age of 3 who were otherwise healthy with no comorbidities who had post-operative complications.

Conclusion: Children <3 years of age had no significant increase in risk of respiratory complications after tonsillectomy surgery. Comorbidities such as craniofacial malformations were more indicative of respiratory complications rather than age. Thus, decisions to admit a patient post-operatively should be made on a case-bycase basis depending on comorbidities rather than admitting all patients under 3 years, allowing better utilization of hospital resources without compromising patient safety.