(A1221) Trends in Pediatric Sleep Surgery

Introduction: There are a variety of surgical procedures available for the treatment of pediatric obstructive sleep apnea (OSA) depending on patient history and site of airway collapse. Prior studies have shown increases in procedures such as lingual tonsillectomy (LT) and supraglottoplasty (SGP) through the 1990s and 2000s. We sought to further study these trends through the 2020s compared to tonsillectomy and adenoidectomy (T&A).

Methods: A retrospective review was performed using the TriNetX database. A search was performed for patients aged 12 years or younger diagnosed with OSA between 2010 and 2024 using ICD-10 code G47.33. Tonsillectomy and adenoidectomy were identified using CPT code 1007178 and SNOMED Code 28913000. Lingual tonsillectomy was identified using CPT code 42870 and SNOMED code 47823003. Supraglottoplasty was identified using CPT codes 31540, 31541, 31560, 31561 and 31599.

Results: 301537 patients were included in the study. The mean age was 5.52 years (SD=3.28). Compared to T&A, there were significantly higher percentages of patients with comorbid heart disease, lung disease, Trisomy 21, genetic syndromes and laryngomalacia in the SGP and LT groups (p < 0.001 for all). T&A was the most common procedure (N=104225, 34.5%), while SGP (N=2937, 1.0%) and LT (N=999, 0.3%) were rare (p <.001). From 2010 to 2024, rates of T&A increased by 191.8%, LT by 226.2%, and SGP by 290.0% (p <.001 for all). One-way ANOVA revealed significant differences in mean age among surgical groups. Tukey’s HSD showed the youngest mean age for SGP (3.39 years, SD= 3.32), followed by T&A (5.52 years, SD=2.83), and LT (7.37 years, SD=2.94), with all differences being statistically significant (p <.001).

Conclusions: Both LT and SGP have an increased role in management of pediatric OSA reflecting a shift to more comprehensive and anatomy specific sleep surgery in pediatric otolaryngology.