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What is already known: respiratory complications after tonsillectomy are predicted by an age <2 years, the presence of an orofacial malformation or a systemic illness conditions.
What this article adds: the current study found that weight <18kg is a strong predictor of postoperative respiratory complication after tonsillectomy in patients in whom no known risk factor is present.
Implications for translation: even in patients older than 2 years with no risk factor of postoperative respiratory complications, patients with a weight <18kg should be considered as at risk of postoperative respiratory complications.
Tonsillectomy is considered as a therapeutic option in obstructive sleep apnoea syndrome (OSAS). Postoperative respiratory failure is a complication that can require respiratory support. The main objective of our study is to determine risk factors of postoperative respiratory complications in children undergoing tonsillectomy.
Material and methods
This is a retrospective single centre observational study including patients with unanticipated postoperative respiratory failure. Patients with a planned preoperative intensive care admission were excluded (age is lower than 2 years, overweight (>95% percentile of BMI), moderate or severe asthma, major medical conditions). Those patients were compared with randomly selected control patients. Factors studied were: age, weight, indication of surgery, ASA status, preoperative illness conditions, durations of surgery and anaesthesia and administered medications. Statistics used a univariate analysis and a multivariate logistic regression.
Eight hundred and five patients underwent adenotonsillectomy during the study period and 25 developed postoperative respiratory failure. These patients were compared to 103 non-complicated control patients. Age (<4 years), weight (<18kg), indication of surgery (as SOAS), laryngomalacia, stable and minor congenital cardiac malformation and duration of anaesthesia were found statistically associated. Multivariate analysis found that weight <18kg is a risk factor associated with the occurrence of postoperative respiratory failure. Overall the model shows a strong accuracy with an area under the curve of ROC analysis of 0.9 [95% confidence interval: 0.85–0.95].
Our study found that weight <18kg is a major risk factor for predicting a postoperative respiratory complication.Le texte complet de cet article est disponible en PDF.
Keywords : Adenotonsillectomy, Postoperative respiratory failure, Children, Risk factors