Hill Courtney A, Litvak Andrea, Canapari Craig, Cummings Brian, Collins Corey, Keamy Donald G, Ferris Timothy G, Hartnick Christopher J
Department of Otology and Laryngology, Harvard Medical School, United States.
Int J Pediatr Otorhinolaryngol. 2011 Nov;75(11):1385-90. doi: 10.1016/j.ijporl.2011.07.034. Epub 2011 Aug 25.
A pilot study to identify risk factors predicting post-operative complications in children with severe OSA undergoing adenotonsillectomy.
Retrospective review in a tertiary care academic institution. Two-stage least squares regression analysis and instrumental variable analysis to allow for modeling of pre- and peri-operative risk factors as having significance in predicting post-operative morbidity.
Eighty-three children (mean age 4.88 ± 3.09 years) with apnea-hypopnea index (AHI) ≥ 10 who were observed overnight following adenotonsillectomy were evaluated for rates of major (increased level of care, CPAP/BiPAP use, pulmonary edema and reintubation) and minor (oxygen saturation <90%) airway complications as well as total observation costs. Major and minor complications occurred in 4.8% and 19.3% of children, respectively. Age <2 years (p<0.01), AHI >24 (p<0.05), intra-operative laryngospasm requiring treatment (p<0.05), oxygen saturations <90% on room air in PACU (p<0.05) and PACU stay >100 min (p<0.01) independently predicted post-operative complications. Children with any one of these factors experienced a 38% complication rate versus 4% in all others.
This pilot study identified pre- and peri-operative risk factors that collectively can be investigated as predictors of post-operative airway complications in a prospective study. By identifying preliminary results comparing the complication rates between those children with and without these risk factors, we will be able to calculate the sample size for a future prospective validation study. Such a study is necessary to understand the safety and potential significant cost savings of observing children without risk factors on the pediatric floor and not in an ICU setting. A best practice algorithm can be created for children with severe OSA only after completing this prospective study.
一项初步研究，旨在确定预测重度阻塞性睡眠呼吸暂停（OSA）患儿行腺样体扁桃体切除术后并发症的危险因素。
在一家三级医疗学术机构进行回顾性研究。采用两阶段最小二乘回归分析和工具变量分析，以便对术前和围手术期危险因素进行建模，这些因素对预测术后发病率具有重要意义。
对83例腺样体扁桃体切除术后过夜观察的呼吸暂停低通气指数（AHI）≥10的患儿（平均年龄4.88±3.09岁）进行评估，观察主要（护理级别提高、使用持续气道正压通气/双水平气道正压通气、肺水肿和再次插管）和次要（血氧饱和度<90%）气道并发症发生率以及总观察费用。主要和次要并发症分别发生在4.8%和19.3%的患儿中。年龄<2岁（p<0.01）、AHI>24（p<0.05）、术中需要治疗的喉痉挛（p<0.05）、麻醉后监护病房（PACU）空气中血氧饱和度<90%（p<0.05）以及PACU停留时间>100分钟（p<0.01）独立预测术后并发症。有这些因素之一的患儿并发症发生率为38%，而其他患儿为4%。
这项初步研究确定了术前和围手术期的危险因素，这些因素可在前瞻性研究中作为术后气道并发症的预测因素进行综合研究。通过比较有和没有这些危险因素的患儿之间的并发症发生率得出初步结果，我们将能够计算未来前瞻性验证研究的样本量。只有在完成这项前瞻性研究后，才能为重度OSA患儿创建最佳实践算法。
