Can risk factors for oxygen desaturation be predictors for post-operative apneic death in pediatric obstructive sleep apnea (OSA) patients?
Background: Recognition of treatment benefits for childhood OSA has led to more adenotonsillectomies being performed for sleep-related conditions. Major respiratory complications and death are rare, making risk factors all but impossible to study formally; however, risk factors for post-operative desaturation may be similar to those for post-operative apneic death.
Explore this issue:October 2013
Study design: A retrospective analysis of 4,092 consecutive patients undergoing tonsillectomy who postoperatively desaturated between Jan. 5, 2009 and May 9, 2011.
Setting: Children’s Hospital Boston and two satellite centers.
Synopsis: A case was defined as any patient who had a recorded sustained oxygen saturation of <90 percent in medical or nursing post-operative notes or in the vital signs log in the first 24 post-operative hours. During the study period, 294 patients had oxygen saturations <90 percent recorded during their hospital stay; the mean saturation nadir was 78.7 percent, with a minimum documented saturation of 10 percent. The children who desaturated were, on average, younger, were either smaller or heavier for their age and were slightly more likely to have had their tonsillectomy performed for OSA. At least one medical comorbidity was present in 68.37 percent of the desaturation group and 35.33 percent of the nondesaturation group. The mean apnea-hypopnea index (AHI) was significantly higher in patients who desaturated post-operatively; however, an AHI of 10 was no more predictive of desaturation than an AHI of 3. Limitations included the assumption that if patients did not experience desaturation, they could be included as controls, reliance on an imperfect clinical OSA diagnosis and that 35 percent of the control population had at least one comorbidity.
Bottom line: Oxygen desaturation to <90 percent occurs in 7 percent of patients following adenotonsillectomy in a tertiary care center. It may not be possible to identify an algorithm that admits all children at desaturation risk while allowing discharge of a high percentage of patients.
Citation: Kieran S, Gorman C, Kirby A, et al. Risk factors for desaturation after tonsillectomy: analysis of 4,092 consecutive pediatric cases. Laryngoscope. 2013;123:2554-2559.
—Reviewed by Amy Eckner