Nineteen percent of children who underwent adenotonsillectomy (AT) experienced a postoperative complication, with 9.4% experiencing respiratory compromise, the most frequent complication, and 2.6% having secondary hemorrhage, according to a meta-analysis published online September 21 in Pediatrics. The researchers also found that children with obstructive sleep apnea (OSA) appear 4.9 times more likely to suffer respiratory complications than children without OSA.
"Regarding the most frequent early postoperative complications, respiratory compromise and hemorrhage were the most frequent, followed by pain, fever, nausea and vomiting, and dehydration," Graziela De Luca Canto, DDS, PhD, from the Department of Dentistry, Federal University of Santa Catarina, Florianopolis, Brazil, and the School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Canada, and colleagues write.
"Thus, AT has substantial postoperative morbidity, and identification of children at risk for either respiratory compromise or bleeding would be obviously important, particularly because the majority of AT surgeries are conducted in outpatient settings."
The researchers initially identified 1254 citations by searching six electronic databases and Google Scholar and consulting with content experts. Of those citations, 23 studies with sample sizes ranging from 102 to 9023 subjects met the authors' inclusion criteria. Four studies within that group differentiated postoperative complications suffered by pediatric patients who did or did not have OSA.
According to Dr De Luca Canto and coauthors, in the last decade, AT surgery for OSA has increased sharply and now has become "the current treatment of choice" for children "due to its perceived efficacy and cost effectiveness." In the United States, more than 530,000 such procedures are performed on children each year.
"In this context, our meta-analysis highlights 2 relevant clinical practice points. The presence of OSA significantly increases the odds for postoperative respiratory complications, with children with OSA exhibiting a nearly fivefold increase in the odds of developing respiratory complications when compared with children without OSA," the researchers write. Specifically, the odds ratio was 4.90 (95% confidence interval, 2.38 - 10.10).
Conversely, children with OSA had approximately a significantly lower risk of bleeding complications than did children without OSA (odds ratio, 0.41; 95% confidence interval, 0.23 - 0.74).
Among the limitations of the meta-analysis, Dr De Luca Canto and colleagues note that the published studies did not use overnight polysomnography to define the severity of OSA. Still, because the disorder heightens children's risks, including during and after anesthesia, the authors suggest that anesthesiologists screen patients for snoring and comorbidities. More systematic use of polysomnography-based diagnosis could help steer high-risk patients to facilities better equipped for complex pediatric patients, they write.
"Based on the current limited evidence, children with OSA appear to have more respiratory complications after AT than children without OSA," the authors conclude. "In contrast, hemorrhage appears to be more frequent in children without OSA."
Three researchers received grants from the National Institutes of Health and the American Heart Association. The remaining authors have disclosed no relevant financial relationships.
Pediatrics. Published online September 21, 2015. Abstract
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