Publication related to RSI or an RSI staff member
Risk factors for respiratory adverse events after adenoidectomy and tonsillectomy in children with down syndrome: a retrospective cohort study.
Authors
- Xiao, Lena, Xiao L, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, K1H 8L1, Canada.; University of Ottawa, Ottawa, Canada.
- Barrowman, Nicholas, Barrowman N, University of Ottawa, Ottawa, Canada.; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.
- Momoli, Franco, Momoli F, University of Ottawa, Ottawa, Canada.; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.; Ottawa Hospital Research Institute, Ottawa, Canada.
- Murto, Kimmo, Murto K, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, K1H 8L1, Canada.; University of Ottawa, Ottawa, Canada.; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.
- Bromwich, Matthew, Bromwich M, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, K1H 8L1, Canada.; University of Ottawa, Ottawa, Canada.; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.
- Katz, Sherri L, Katz SL, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, K1H 8L1, Canada. skatz@cheo.on.ca.; University of Ottawa, Ottawa, Canada. skatz@cheo.on.ca.; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada. skatz@cheo.on.ca.
Obstructive sleep apnea syndrome is a major cause of morbidity in the Down syndrome population and is commonly treated with adenoidectomy and/or tonsillectomy (AT). However, these children are at increased risk for perioperative respiratory adverse events (PRAEs). The objective of this study was to examine risk factors for major PRAEs requiring intervention in children with Down syndrome undergoing AT and to describe their postoperative monitoring environment. This retrospective study included all children with Down syndrome aged 0-18 years who underwent a preoperative polysomnogram followed by AT at a tertiary pediatric institution. Descriptive statistics were used to summarize baseline demographic and clinical characteristics. A multivariable model for prediction of PRAEs was constructed. A priori, it was decided that minimum oxygen saturation, apnea-hypopnea index, and average oxygen saturation asleep would be included, along with medical comorbidities associated with PRAEs at p 0.15. Fifty-six children were admitted for monitoring overnight; four were admitted to the intensive care unit and fifty-two were admitted to the ward. CONCLUSIONS: A multivariable model found evidence that lower average oxygen saturation while asleep was associated with PRAEs requiring intervention in children with Down syndrome. This study highlights the difficulty in predicting complications in this population. WHAT IS KNOWN: * Obstructive sleep apnea syndrome is a major cause of morbidity in the Down syndrome population and is commonly treated with adenoidectomy and/or tonsillectomy. * However, children with Down syndrome are at increased risk for perioperative respiratory adverse events (PRAEs) following adenoidectomy and/or tonsillectomy. WHAT IS NEW: * We found that a lower average oxygen saturation asleep is associated with increased odds of PRAEs, adjusting for age, total apnea-hypopnea index, cardiac comorbidity, and minimum oxygen saturation. * This study highlights the difficulty in predicting complications in this population.
