Pre‐operative parameters do not reliably identify post‐operative respiratory risk in children undergoing adenotonsillectomy

Aim Adenotonsillectomy is performed in children with recurrent tonsillitis or obstructive sleep apnoea. Children at risk of post‐operative respiratory complications are recommended to be monitored in paediatric intensive care unit (PICU). The aim of the study is to review the risk factors for post‐operative complications and admissions to PICU. Methods A review of medical records of children who underwent adenotonsillectomy between January 2011 and December 2014 was performed. Association between demographic variables and post‐operative complications were examined using chi‐square and Mann–Whitney tests. Results A total of 214 children were identified, and of these, 19 (8.8%) experienced post‐operative complications. Six children (2.8%) had respiratory complications: hypoxaemia in four and laryngospasm requiring reintubation in a further two. Both of the latter patients were extubated upon arrival to PICU and required no escalation of therapy. A total of 13 (6.1%) children had non‐respiratory complications: 8 (3.7%) had infection and 5 (2.3%) had haemorrhage. A total of 26 (12.1%) children were electively admitted to PICU and mean stay was 19.5 (SD ± 13) h. No association between demographic characteristics, comorbid conditions or polysomnographic parameters and post‐operative complications were noted. A total of 194 (90.7%) children stayed only one night in hospital (median 1 day, range 1–5 days). Conclusion The previously identified risk factors and criteria for PICU admission need revision, and new recommendations are necessary.