Severe OSA and Prolonged PICU Admissions after Tonsillectomy

Abstract

Objective Determine the factors that increase the rate of a complicated postoperative course for children undergoing adenotonsillectomy for polysomnogram (PSG) proven severe OSA. Methods A retrospective chart review of children with PSG-verified severe OSA admitted to PICU after adenotonsillectomy was completed for the years 2002–2006. Data gathered: complications, style of tonsillectomy, direct laryngoscopy and bronchoscopy (DLB) findings, length of stay in PICU and hospital, age, co-morbidities, American Society of Anesthesiologists (ASA) grading, PSG indices: AI, RDI, ETCO2, and nadir O2. Two groups were separated and compared: those that remained intubated after surgery and those extubated and managed with conservative postoperative airway intervention. Results 70 children with PSG-verified severe OSA were admitted to PICU after adenotonsillectomy. 53 children were extubated postoperatively. 43% of these children required oxygen supplementation, BiPAP or CPAP, and none required re-intubation. 17 children remained intubated postoperatively. The style of tonsillectomy and all of the PSG indices were not significantly different between the two groups. Postoperative complication rates among children who remained intubated was 47%, compared to children who were not intubated at 2%. Intubated children's PICU and total hospital stay was longer. They were younger, and their ASA grading was higher. All of these differences were statistically significant. Conclusions Children who remain intubated after adenotonsillectomy have more postoperative complications and stay in the hospital longer. Every attempt should be made to extubate children postoperatively and manage them with conservative airway management after tonsillectomy.