Postoperative Respiratory Complications After Adenotonsillectomy in Children With High‐Risk Obstructive Sleep Apnea

Abstract Objective Identify patient characteristics and polysomnogram (PSG) parameters associated with postoperative respiratory complications after adenotonsillectomy (AT) among children with high‐risk obstructive sleep apnea (OSA). Study Design Case series with chart review. Setting Tertiary care children's hospital. Methods Pediatric patients (30, O 2 nadir 60 mm Hg) on overnight PSG from 2019 to 2021 were included. Primary outcomes were major respiratory intervention during the postoperative admission, prolonged hospitalization, and intensive care unit (ICU) stay. Results A total of 307 patients met inclusion criteria. Median age was 6.5 years and 63% were male. Twenty‐five (8.1%) required major respiratory intervention and 29 (9.7%) required ICU admission after AT. Major interventions and ICU admissions were significantly associated with neuromuscular disease ( P < .01), higher obstructive apnea‐hypopnea index (oAHI), higher CO 2 peak, and lower O 2 nadir. Prolonged admission had similar findings except oAHI was not significantly associated. Younger children were significant more likely to require ICU admission or prolonged admission. Conclusion Increased oAHI and worsening O 2 and CO 2 parameters on preoperative PSG were associated with postoperative respiratory complications in children with high‐risk OSA. Children with neuromuscular disease and age 0 to 2 had higher risk of ICU stay and prolonged hospitalization. Clinicians should recognize the importance of parameters beyond oAHI when anticipating postoperative monitoring.