Admission Criteria for Children With Obstructive Sleep Apnea After Adenotonsillectomy: Considerations for Cost

Study Objectives: Postoperative respiratory complications (PRCs) are common among children with obstructive sleep apnea (OSA) after adenotonsillectomy. We analyzed postoperative admission guidelines to determine which optimally balanced patient safety and cost. Methods: Retrospective study of children aged 12 years or younger undergoing adenotonsillectomy for OSA after polysomnography at a tertiary academic care center over 2 years. Demographics, medical history, and hospital course were collected. Advanced Excel modeling was used to assess the number of children with PRCs identified with guideline admission criteria and to validate the significance of these findings in our patient population with logistic regression. Results: Six hundred thirty children were included; 116 had documented PRCs. Children with PRCs were younger (P=.024) and more frequently male (P=.012). There were no significant differences in race (P=.411) or obesity (P=.265). More children with PRCs had an apnea-hypopnea index (AHI) > 24 events/h (P<.001). Following guidelines from the American Academy of Pediatrics, American Academy of Otolaryngology-Head and Neck Surgery, and Nationwide Children's Hospital, 82%, 87%, and 99% of children with PRCs would be identified, costing $535,962, $647,165, and $1,053,694 for admission, respectively. Using a non-validated, forced model to refine predictors described in published guidelines, our model would have identified 95% of children with one or more PRCs, with a moderate cost. Conclusions: Current admission guidelines attempt to identify children with OSA at high risk for PRCs after adenotonsillectomy; however, none consider the economic cost to the health care system. We present a comparison of the number of patients identified with PRCs after adenotonsillectomy and the cost of expected admissions using currently published guidelines.