Tonsillectomy for sleep apnea more risky in young children

[unseennude]

Children younger than 3 years of age who undergo adenotonsillectomy for obstructive sleep apnea (OSA) are at greater risk for respiratory complications than their older peers and, therefore, probably should be hospitalized, according to a new report.

Advances in anesthesia and surgical techniques have led third-party payers to place pressure on doctors to perform adenotonsillectomy as an outpatient procedure, senior author Dr. Maninder Kalra and colleagues, from Cincinnati Children's Hospital Medical Center in Ohio, note. However, it was unclear if age played any role in determining whether the surgery should be done on an outpatient basis.

To investigate, the researchers analyzed data from all children younger than 6 years of age who underwent adenotonsillectomy for OSA at their center between June 1999 and May 2001.

The new findings appear in the May issue of the Archives of Otolaryngology: Head and Neck Surgery.

Of the 2315 children included in the study, 149 (6.4%) developed postoperative respiratory complications, the authors note.

Although children younger than 3 years of age had fewer comorbidities than their older counterparts, they experienced twice the rate of respiratory complications: 9.8% vs. 4.9% (p < 0.001). Logistic regression analysis confirmed the independent contribution of age on the risk of complication, with an odds ratio of 1.98.

"Our results are in agreement with previous studies that report an increased risk for postoperative respiratory complications in children younger than 3 years," the authors state. The findings provide "additional evidence for guidelines from the Academy of Otolaryngology Head and Neck Surgery promoting inpatient adenotonsillectomy in patients younger than 3 years."