Chang I-S, Kang K-T, Tseng C-C, Weng W-C, Hsiao T-Y, Lee P-L, Hsu W-C
Department of Otolaryngology, National Taiwan University, College of Medicine and National Taiwan University Hospital, Taipei, Taiwan.
Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.
Clin Otolaryngol. 2018 Feb;43(1):39-46. doi: 10.1111/coa.12899. Epub 2017 May 28.
To investigate emergency room (ER) revisits and hospital readmissions following adenotonsillectomy (T&A) in children with sleep-disordered breathing (SDB), and correlations between SDB severity and ER revisits.
Retrospective chart review study.
Tertiary referral centre.
610 consecutive children underwent T&A for treating SDB.
Sleep-disordered breathing severity was defined according to the apnoea-hypopnoea index (AHI) (primary snoring = AHI < 1; mild = AHI 1-5; moderate = AHI 5-10; and severe = AHI > 10). Revisit and readmission patterns within 30 days of the surgery were extracted and analysed.
Of these children (mean age = 7.2 years; males = 72%), 49 (8.0%) had first ER revisit, nine (1.5%) had second ER revisits, and one (0.2%) had third ER revisits. Reasons for ER revisits were bleeding related (46%) or non-bleeding related (54%). The timing for revisits was 6.9±1.9 postoperative days for bleeding-related revisits and 9.3±10.0 days for non-bleeding-related revisits. Treatment strategies during these revisits were treat and release in 44 children (74.6%), admission for observation in eight children (13.5%), and admission for surgery in seven children (11.9%). The incidence of ER revisit and hospital readmission was similar among children with all levels of SDB severity. Multivariable logistic regression analysis showed that young children (<3 years) experienced an increased risk of non-bleeding-related revisits (odds ratio [OR] = 4.1).
Children with severe SDB do not experience increased risks of revisit or readmission; however, young children are at increased risk of non-bleeding-related revisits.
探讨睡眠呼吸障碍（SDB）患儿行腺样体扁桃体切除术（T&A）后的急诊室复诊及再次入院情况，以及SDB严重程度与急诊室复诊之间的相关性。
回顾性病历审查研究。
三级转诊中心。
610例连续接受T&A治疗SDB的儿童。
根据呼吸暂停低通气指数（AHI）定义睡眠呼吸障碍严重程度（单纯打鼾=AHI<1；轻度=AHI 1-5；中度=AHI 5-10；重度=AHI>10）。提取并分析术后30天内的复诊和再次入院模式。
这些儿童（平均年龄=7.2岁；男性占72%）中，49例（8.0%）首次急诊室复诊，9例（1.5%）第二次急诊室复诊，1例（0.2%）第三次急诊室复诊。急诊室复诊原因与出血相关（46%）或与非出血相关（54%）。出血相关复诊的时间为术后6.9±1.9天，非出血相关复诊的时间为9.3±10.0天。这些复诊期间的治疗策略为44例儿童（74.6%）治疗后出院，8例儿童（13.5%）入院观察，7例儿童（11.9%）入院手术。所有SDB严重程度级别的儿童中，急诊室复诊和再次入院的发生率相似。多变量逻辑回归分析显示，幼儿（<3岁）非出血相关复诊风险增加（比值比[OR]=4.1）。
重度SDB患儿复诊或再次入院风险未增加；然而，幼儿非出血相关复诊风险增加。
