McCormick Michael E, Sheyn Anthony, Haupert Michael, Thomas Ronald, Folbe Adam J
Department of Otolaryngology-Head & Neck Surgery, Wayne State University School of Medicine, Detroit, MI, United States.
Int J Pediatr Otorhinolaryngol. 2011 Nov;75(11):1391-4. doi: 10.1016/j.ijporl.2011.07.035. Epub 2011 Sep 1.
To identify risk factors for complications in the first 24h after surgery in the young (<4 years old) adenotonsillectomy patient.
A retrospective chart review was performed at a tertiary care children's hospital. Consecutive records of all children of age 3 years and younger undergoing adenotonsillectomy over a 5 year period were included in the study. The main outcomes measured were total and airway complications occurring on post-operative days 0-1.
993 patients were included in the study. The mean age was 2.94 years old. Witnessed apneas (74.1%) and snoring (59.2%) were the most frequent pre-operative symptoms. 700 children were admitted with a mean length-of-stay of 1.22 days (0-9 days) and a mean time-to-oral intake of 0.28 days (0-4 days) among those patients admitted. The total number of complications was 102 in 98 patients (9.9%). There were 35 complications on post-operative days (POD) 0-1 (3.5%), and 23 of those were airway-related (2.3%). With regard to all complications on POD 0-1, significant predictors were nasal obstruction, gastroesophageal reflux disease, prematurity and a history of cardiovascular anomalies. Significant predictors of airway complications on POD 0-1 were younger age (1-2 years old), larger adenoid size, nasal obstruction, and a history of cardiovascular anomalies.
Knowing the stated risk factors for complications in the early post-operative period after adenotonsillectomy in the younger pediatric patient can help select certain patients for closer monitoring. Specifically, children aged 1-2 years old with a history of nasal obstruction from large adenoids, gastroesophageal reflux disease, prematurity, and/or cardiovascular anomalies appear to be at higher risk for early complications and should warrant closer observation.
确定年龄小于4岁的小儿腺样体扁桃体切除术后24小时内并发症的危险因素。
在一家三级儿童专科医院进行回顾性病历审查。研究纳入了5年间所有接受腺样体扁桃体切除术的3岁及以下儿童的连续记录。主要测量的结果是术后0至1天出现的总体并发症和气道并发症。
993例患者纳入研究。平均年龄为2.94岁。术前最常见的症状是观察到的呼吸暂停（74.1%）和打鼾（59.2%）。700名儿童入院，平均住院时间为1.22天（0至9天），入院患者中平均经口进食时间为0.28天（0至4天）。98例患者（9.9%）出现并发症102例。术后0至1天（POD）出现35例并发症（3.5%），其中23例与气道相关（2.3%）。关于POD 0至1的所有并发症，显著的预测因素是鼻塞、胃食管反流病、早产和心血管异常病史。POD 0至1气道并发症的显著预测因素是年龄较小（1至2岁）、腺样体较大、鼻塞和心血管异常病史。
了解小儿腺样体扁桃体切除术后早期并发症的上述危险因素有助于选择某些患者进行密切监测。具体而言，1至2岁、有腺样体肥大导致鼻塞病史、胃食管反流病、早产和/或心血管异常的儿童似乎早期并发症风险较高，应予以密切观察。
