Polysomnographic parameters and clinical risk factors predicting postoperative respiratory complications in children undergoing lingual tonsillectomy

Abstract

Objective: Postoperative respiratory complications (PORC) are one of the complications following lingual tonsillectomy. Limited data exist for clinical risk factors and preoperative polysomnogram (PSG) parameters predicting PORC, which can guide the utilization of resources for postoperative patient care. This study aimed to identify those risk factors. Methods: A retrospective study was performed in children undergoing LT with available preoperative PSG. Results: 107 children who underwent LT met inclusion criteria for analysis with corresponding preoperative PSGs. The median age (IQR range) at the time of PSG was 10 (6.9,13.0) years. A total of 20 patients (18.7 %) PORC was identified. Compared to those without complications, children with PORC had a higher proportion of congenital heart disease (65.0 % vs 39.5 %; P < 0.05), higher median AHI (median 14.0 vs. 8.0; P < 0.05), higher obstructive AHI (median 11.6 vs 7.4; P < 0.05), lower SpO2 nadir (median 79.6 vs. 86.4; P < 0.05) and higher percentage of EtCO2 (median 21.3 vs. 4.6; P < 0.05). The unadjusted odds ratio (OR) indicated an increased risk of PORC in patients with congenital heart disease (OR 2.84, P < 0.05). Multiple logistic regression analysis revealed that congenital heart disease was the only significant independent risk factor for PORC (P < 0.05), while there was a trend toward significant risk factor of severe OSA (obstructive AHI >10) for PORC with an adjusted odds ratio of 2.76 (CI 0.98–7.76; P = 0.054). Conclusions: In our cohort study of children undergoing LT, those with congenital heart disease, higher AHI, higher obstructive AHI, lower SpO2 nadir and a higher percentage of EtCO2 >50 mmHg were more likely to develop PORC. Congenital heart disease was the only independent risk factor for PORC. Clinical risk factors and specific preoperative PSG parameters are important in peri-operative planning care for children undergoing LT.