PREDICTIVE FACTORS FOR RESPIRATORY COMPLICATIONS AFTER TONSILLECTOMY AND ADENOIDECTOMY IN CHILDREN

Objective: To determine risk factors predictive of outcomes to aid in the cost-effective preoperative evaluation and postoperative managemen t of patients who are undergoing tonsillectomy and adenoidectomy for o bstructed breathing during sleep. Design: A historical cohort study wi th a nested case-control analysis that examined risk factors associate d with postoperative respiratory complications. Setting: Children's Me dical Center of Dallas, Dallas, Tex, which is a pediatric referral hos pital for secondary and tertiary pediatric care with both private and university-appointed physicians. Patients: A convenience sample of 355 patients who were undergoing tonsillectomy and adenoidectomy for obst ructed breathing during sleep throughout a 1-year period. Intervention : None. Main Outcome Measure: The occurrence of postoperative complica tions, including airway obstruction, apneas with oxygen desaturations, airway interventions (eg, endotracheal intubation), or administration of supplemental oxygen, as they related to associated medical conditi ons (eg, cerebral palsy or prematurity) and diagnostic tests (eg, ches t x-ray film and electrocardiogram). Results: Five associated medical conditions (cerebral palsy; seizures; age, less than or equal to 3 yea rs; congenital heart disease; and prematurity) were identified as impo rtant predictors of a complicated postoperative course using stepwise logistic regression analysis. Those children with an abnormal chest x- ray film pr electrocardiogram were also identified as having an associ ated medical condition that was predictive of postoperative complicati ons. Conclusions: Children with 1 or more of the associated risk facto rs identified should be considered candidates for postoperative inpati ent observation. A preoperative chest x-ray film and electrocardiogram were found to be of little predictive value, and they are probably no t cost-effective screening tests for postoperative respiratory complic ations.