(A943) Postoperative Complications in Children Under 3 Years of Age Undergoing Tonsillectomy and Adenoidectomy

Introduction: Tonsillectomy and adenoidectomy (T&A) are surgeries for tonsillitis and obstructive sleep apnea (OSA) in children. Although generally safe, complications can lead to readmission or additional surgery. American Academy of Otolaryngology-Head and Neck Surgery guidelines recommend overnight monitoring for children < 3 years due to higher risks. This study explores postoperative complications in children under 3 undergoing T&A.

Methods: A retrospective chart review was conducted at an academic medical center on children under 3 who had T&A from 2021 to 2023. Demographics, comorbidities, perioperative details, and postoperative outcomes were analyzed. Postoperative complications were defined as unplanned Pediatric Intensive Care Unit (PICU) admissions or ER visits within 30 days. Pearson and Wilcoxon tests assessed relationships between post anesthesia care unit (PACU) times, oxygen requirements, comorbidities, and complications.

Results: The cohort included 582 patients (54% male, 46% female), mostly non-Hispanic (69%), born at term (80%), with median body-mass index percentile 59.85. Children with planned PICU admissions had higher oxygen nadirs (82.08% vs. 67.14%, p< 0.001), less need (9% vs. 23%, p< 0.001) and shorter supplemental oxygen delivery (16.4 min vs. 34.9 min, p=0.02) in PACU. Comorbidities like asthma (p < 0.001), cardiovascular conditions (p=0.032), and obstructive apnea-hypoxic indices (32.39 vs. 9.01, p< 0.001) were predictors of complications. Pain, dehydration (35%, p< 0.001), bleeding (38%, p< 0.001), and respiratory symptoms (4%, p< 0.001) were predictive of ER visits within 30 days.

Conclusions: Other studies have found obstructive apneas and comorbidities not to be a predictor of postoperative complications. Our study found obstructive apneas, asthma, and cardiovascular conditions to be significant predictors of postoperative complications. Khasawneh et al. reported a 5.7% dehydration rate postoperatively, while our study found 35%. Our study highlights the importance of close postoperative monitoring, especially for children with comorbidities and OSA.