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Risk factors for respiratory adverse events after adenoidectomy and tonsillectomy in children with down syndrome: a retrospective cohort study

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Abstract

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 < 0.2 in univariable analyses. Fifty-eight children were included in this study; twelve had a PRAE. Cardiac disease was associated with PRAEs on univariable analysis (p = 0.03). In multivariable analysis, average oxygen saturation asleep was associated with PRAEs (OR 1.50; 95% confidence interval 1.00, 2.41; p = 0.05). For all of the remaining variables, 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.

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Data availability

Data available on request from the authors.

Code availability

Code available on request from the authors.

Abbreviations

AHI:

Apnea-hypopnea index

ASA:

American Society of Anesthesiologists

AT:

Adenoidectomy and/or tonsillectomy

BMI:

Body mass index

CHD:

Congenital heart disease

IQR:

Interquartile range

PACU:

Post-anesthetic care unit

PaO2:

Partial pressure of oxygen

PICU:

Pediatric intensive care unit

PRAE:

Perioperative respiratory adverse event

PSG:

Polysomnogram

OSAS:

Obstructive sleep apnea syndrome

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Acknowledgements

We would like to thank Dr. Indra Narang for reviewing this manuscript.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Dr. Katz has received a speaker honorarium from Biogen, unrelated to this work.

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Authors and Affiliations

  1. Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, K1H 8L1, Canada

    Lena Xiao, Kimmo Murto, Matthew Bromwich & Sherri L. Katz

  2. University of Ottawa, Ottawa, Canada

    Lena Xiao, Nicholas Barrowman, Franco Momoli, Kimmo Murto, Matthew Bromwich & Sherri L. Katz

  3. Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Canada

    Nicholas Barrowman, Franco Momoli, Kimmo Murto, Matthew Bromwich & Sherri L. Katz

  4. Ottawa Hospital Research Institute, Ottawa, Canada

    Franco Momoli

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  1. Lena Xiao
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Contributions

All authors have read and approved of this article’s submission. Dr. Katz was the principal investigator for the study, conceived and designed the study. Drs. Barrowman, Bromwich, Momoli, and Murto contributed to the design of the study and revised the manuscript. Dr. Barrowman was involved in the statistical analysis of data. Dr. Xiao contributed to the design of the study, completed data collection, and wrote the first draft of the manuscript.

Corresponding author

Correspondence to Sherri L. Katz.

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Ethics approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Research Ethics Board of the Children’s Hospital of Eastern Ontario approved this study.

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This type of study does not require informed consent.

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This type of study does not require individual consent to publish.

Competing interests

The authors declare no competing interests.

Additional information

Communicated by Peter de Winter

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Work for this study was performed at the Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, Canada, K1H 8L1.

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Cite this article

Xiao, L., Barrowman, N., Momoli, F. et al. Risk factors for respiratory adverse events after adenoidectomy and tonsillectomy in children with down syndrome: a retrospective cohort study. Eur J Pediatr 181, 2399–2408 (2022). https://doi.org/10.1007/s00431-022-04438-3

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  • DOI: https://doi.org/10.1007/s00431-022-04438-3

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