Risk Factors for Postoperative Respiratory Complications in Children With OSAS Undergoing Adenotonsillectomy

Younger than 3 y of age
Severe OSAS on polysomnographya
Cardiac complications of OSAS
Failure to thrive
Craniofacial anomaliesb
Neuromuscular disordersb
Current respiratory infection
  • a It is difficult to provide exact polysomnographic criteria for severity, because these criteria will vary depending on the age of the child; additional comorbidities, such as obesity, asthma, or cardiac complications of OSAS; and other polysomnographic criteria that have not been evaluated in the literature, such as the level of hypercapnia and the frequency of desaturation (as compared with lowest oxygen saturation). Nevertheless, on the basis of published studies (primarily Level III, see Technical Report), it is recommended that all patients with a lowest oxygen saturation <80% (either on preoperative polysomnography or during observation in the recovery room postoperatively) or an AHI ≥24/h be observed as inpatients postoperatively as they are at increased risk for postoperative respiratory compromise. Additionally, on the basis of expert consensus, it is recommended that patients with significant hypercapnia on polysomnography (peak Pco2 ≥60 mm Hg) be admitted postoperatively. The committee noted that that most published studies were retrospective and not comprehensive, and therefore these recommendations may change if higher-level studies are published. Clinicians may decide to admit patients with less severe polysomnographic abnormalities based on a constellation of risk factors (age, comorbidities, and additional polysomnographic factors) for a particular individual.

  • b Not discussed in these guidelines.