Postoperative Respiratory Complications of Adenotonsillectomy for Obstructive Sleep Apnea Syndrome in Older Children: Prevalence, Risk Factors, and Impact on Clinical Outcome

Objective: To determine the prevalence and type of respiratory complications after adenotonsillectomy for obstructive sleep apnea syndrome (OSAS) in otherwise healthy children with a completed preoperative polysomnography evaluation. Design: Retrospective analysis. Setting: Affiliated Hospital of Medical University, Guangzhou, Guangdong, China. Methods: The retrospective chart review focused on the demographic data and pertinent history, preoperative sleep evaluation, surgical and anesthetic management, and need for postoperative respiratory interventions. Improvements in quality of life after adenotonsillectomy for children with OSAS were evaluated using the OSA-18 survey (an 18-item survey on obstructive sleep apnea) completed before, and within 6 months after, surgery. Main Outcome Measures: The percentage of children undergoing adenotonsillectomy to treat OSAS who experience a postoperative respiratory complication. Results: Four hundred seventy-five consecutive cases for adenotonsillectomy were identified, and 321 children met the inclusion criteria. Thirty-six cases (11.2%) had postoperative respiratory complications necessitating a medical intervention. Of the 36, 29 children (80.6%) required an oropharyngeal or nasopharyngeal airway. Twenty-five children (69.4%) experienced multiple episodes of desaturation, and 61.1% of cases (n = 22) had respiratory complications in the postanesthesia care unit. Statistic anlysis showed that the risk factors for complications were young age, obesity, and high preoperative apnea-hypopnea index. Improvements in quality of life as shown by change scores (preoperative score minus postoperative score) were comparable in two groups (p > .05). Conclusions: The most important predictors of postsurgical respiratory morbidity were young age, obesity, and the initial severity of OSAS. Surgical therapy yielded significant improvements in quality of life for children with OSAS, and the amelioration was not linked to the occurrence of postoperative respiratory complications.