In:
Otolaryngology–Head and Neck Surgery, Wiley, Vol. 168, No. 6 ( 2023-06), p. 1535-1544
Abstract:
Few data are available to guide postadenotonsillectomy (AT) pediatric intensive care (PICU) admission. The aim of this study of children with a preoperative polysomnogram (PSG) was to assess whether preoperative information may predict severe respiratory events (SRE) after AT. Study Design Retrospective cohort study. Setting Single tertiary center. Methods Children aged 6 months to 17 years who underwent AT with preoperative polysomnography (2012‐2018) were identified by billing codes. Data were extracted from medical records. SRE were defined as any 1 or more of desaturations 〈 80% requiring intervention; newly initiated positive airway pressure; postoperative intubation; pneumonia/pneumonitis; respiratory code, cardiac arrest, or death. We hypothesized that SRE would be associated with age 〈 24 months, major medical comorbidity, obesity ( 〉 95th percentile), apnea‐hypopnea index (AHI) ≥ 30, and O 2 nadir 〈 70% on PSG. Analysis was performed with multivariable logistic regression. Results Of 1774 subjects, 28 (1.7%) experienced SRE. Compared to those without, children with SRE were on average younger (3 vs 5 years, p 〈 .01) with a greater probability of medical comorbidities (59% vs 18%, p 〈 .001). After adjustment for sex, black race, obesity, and age 〈 24 months, children with major medical comorbidity were more likely than other children to have SRE (odds ratio [OR]: 14.2; 95% confidence interval [CI] : [5.7, 35.2]), as were children with AHI ≥ 30 (OR: 7.7 [3.0, 19.9] ), or O 2 nadir 〈 70% (OR 6.1 [2.1, 17.9]). Age, obesity, sex, and black race did not independently predict SRE. Conclusion PICU admission may be most prudent for children with complex medical co‐morbidities, high AHI ( 〉 30), and/or low O 2 nadir ( 〈 70%).
Type of Medium:
Online Resource
ISSN:
0194-5998
,
1097-6817
Language:
English
Publisher:
Wiley
Publication Date:
2023
detail.hit.zdb_id:
2008453-5
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