Incidence and risk factors of respiratory events after tonsillectomy for obstructive sleep apnea in children with a preoperative indication of intensive care unit admission.

Postoperative respiratory events are a common complication of tonsillectomy for pediatric obstructive sleep apnea (OSA). Despite identified risk factors, there are no validated criteria for systematic postoperative intensive care unit (ICU) admission. In France, an apnea-hypopnea index (AHI) ≥ 10 events/h is a recommended criterion. This study aimed to assess the incidence and risk factors of early postoperative respiratory complications in children undergoing tonsillectomy for OSA with planned ICU admission. We conducted an observational study of children undergoing tonsillectomy between January 2020 and December 2022, with a preoperative ICU indication. Respiratory events were defined as a need of oxygen therapy, noninvasive ventilation (NIV), or tracheal intubation. Collected data included anthropometrics, comorbidities, AHI, gas exchange parameters, and surgical details. Univariate and multivariate analyses were performed for potential risk factors associated with postoperative respiratory complications. 166 children were included (median age 3 years [IQR 2-5]). The median preoperative AHI was 25 events/hour [13-43]. Overall, 159 (96%) patients had at least one comorbidity (45 Down syndrome, 31 obesity and 25 craniofacial malformations). Thirty-four (21%) patients had a respiratory complication: 30 needed oxygen therapy, 4 required NIV. None required an intubation. Age (p < 0.001), percentage of sleep time spent with an Oxygen saturation level < 85% (T85) and < 90% (T90) (p = 0.02 and p = 0.03, respectively) and McGill Oximetry Score (p = 0.01) were significantly associated with respiratory events, whereas neither AHI nor comorbidities showed a significant association.

Conclusion

This study highlights the limited value of AHI alone in predicting respiratory complications post-tonsillectomy.