(1006) Characterizing Postoperative Complications in Pediatric Tonsillectomies Under Three Years of Age

Introduction: The AAO Clinical Practice Guidelines recommend inpatient monitoring of children after tonsillectomy if they are under 3 years old. Our study aims to characterize the postoperative complications associated with tonsillectomy in children under 3 years of age and determine predictors to assist with postoperative admission practices.

Methods: Retrospective review of children under 3 years old who underwent tonsillectomy at a single institution from 2018 to 2022 was performed. Demographics, comorbidities, pre and postoperative polysomnography (PSG) results, intraoperative factors, postoperative respiratory complications, concomitant surgeries, postoperative admissions, and emergency department visits were recorded. Analysis of associations was conducted using Wilcoxon rank-sum and logistic regression.

Results: In total, 498 patients were included. Median age at surgery was 30 months (range: 14-35). Intraoperative factors included oxygen desaturations (45, 9%), laryngospasm (10, 2%), and prolonged extubation (39, 7.8%). Postoperative complications included desaturations (23, 4.6%) and need for airway interventions (56, 11.2%). None required reintubation. Median preop AHI was not significantly different for those with desaturations than those without (5.3, 2.3-7.1 vs 4.5, 0.8-9.6, (p = 0.7). Median O2 nadir on preop PSG was lesser in those with post-operative desaturations than those without (81.5, 62-93 vs 86, 40-94, p = 0.02). In healthy patients (no comorbidities and AHI < 10 (n = 293)), only 12 had postoperative desaturations, most (9) occurring within 4 hours after surgery. Complications were more common in those who experienced laryngospasm (2/4, 50%) than those who did not (10/289, 3.5%) (p = 0.02).

Conclusions: Our study builds on prior literature that described the potential for postoperative tonsillectomy complications in children under 3 years of age. While some patients had postoperative respiratory complications, many were benign, transient, and/or occurred within the first few hours of surgery. Individual factors may help predict which patients require overnight observation.