Predictive factors of early postoperative respiratory complications after tonsillectomy in children with unidentified risks for this complication - 25/11/17

Doi : 10.1016/j.accpm.2017.09.002

Florence Julien-Marsollier ^a,^b, Pierre Salis ^a,^b, Rachida Abdat ^a,^b, Thierno Diallo ^a,^b, Thierry Van Den Abbelle ^b,^c,^d, Souhayl Dahmani ^a,^b,^c,^⁎
^a Department of Anaesthesia, Intensive care and Pain Management, Robert Debré University Hospital, AP–HP, 48, boulevard Sérurier, 75019 Paris, France
^b Paris Diderot University (Paris 7), Pres Paris Sorbonne Cité, 75000 Paris, France
^c Department of Ent-Nose and Throat Surgery, Robert Debré University Hospital, AP–HP, 75019 Paris, France
^d UMR Inserm U 676, Robert Debré University Hospital, 75019 Paris, France

^⁎Corresponding author. Department of Anaesthesia, Intensive care and Pain Management, Robert Debré University Hospital, AP–HP, 48, boulevard Sérurier, 75019 Paris, France.

En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Saturday 25 November 2017
This article has been published in an issue click here to access

Highlights

1)	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.
2)	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.
3)	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.

El texto completo de este artículo está disponible en PDF.

Abstract

Introduction

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.

Results

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].