Adenotonsillectomy for obstructive sleep apnea syndrome in young children - Prevalence of pulmonary complications

Objective: To determine, in a series of children younger than 6 years undergoing adenotonsillectomy for treatment of clinical obstructive sleep apnea syndrome (OSAS), the effect of age on prevalence of postoperative respiratory complications. The primary objective was to define a practice standard for postoperative hospital admission. Design: Retrospective analysis. Setting: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Patients: All children younger than 6 years who underwent adenotonsillectomy to treat OSAS from June 1, 1999, to May 31, 2001. Main Outcome Measures: The percentage of children younger than 3 years undergoing adenotonsillectomy to treat OSAS who experience a postoperative respiratory complication. Results: Of 2315 patients younger than 6 years undergoing an adenotonsillectomy for treatment of OSAS, 149 (6.4%) developed a postoperative respiratory complication. Even though there was a lower incidence of comorbid medical conditions in this cohort, children younger than 3 years were at a greater risk for developing a postoperative respiratory complication compared with those aged 3 to 5 years (9.8% vs 4.9%, P < .001). Logistic regression analysis revealed that children younger than 3 years had a nearly 2-fold increased risk for respiratory complications post-operatively (odds ratio, 1.98; 95% confidence interval, 1.41-2.77) when controlling for race and sex. Conclusions: Adenotonsillectomy to treat OSAS is associated with a significantly higher rate of postoperative respiratory complication in children younger than 3 years compared with children aged 3 to 5 years. Our results support hospital admission for all patients younger than 3 years undergoing adenotonsillectomy for treatment of OSAS.