Risk Factors for Post-Tonsillectomy Respiratory Events in Children With Severe Obstructive Sleep Apnea

Objectives/Hypothesis: To identify risk factors for postoperative respiratory events in pediatric patients with severe obstructive sleep apnea (OSA). Methods: Retrospective single-institution retrospective cohort study of pediatric patients with severe OSA who were admitted postoperatively after tonsillectomy. Patients who experienced respiratory events after surgery were identified and differences between the respiratory event and no event groups were compared. Results: There were 887 patients included in this study. 14.8% (n = 131) experienced a documented respiratory event. The following risk factors were found to be most significant: %sleep time with O₂ < 90% (tb90) (95% CI = 1.07–1.14, OR = 1.10, p < 0.001), Black race (95% CI = 1.53–3.58, OR = 2.34, p < 0.001), primary neurologic co-morbidity (1.67–6.32, OR = 3.27, p < 0.001), Down syndrome (1.25–5.94, OR = 2.72, p = 0.01), and age (0.84–0.94, OR = 0.88, p < 0.001). Regression modeling demonstrated that the rate of respiratory events increased with tb90. Conclusions: Our results demonstrate that there are other potential risk factors outside of AHI and O₂ nadir that are associated with respiratory events after tonsillectomy. Black race and prolonged desaturations during polysomnography (PSG) are independent risk factors. Measures of abnormal gas exchange on PSG may be better at identifying at risk patients. Level of Evidence: 4 Laryngoscope, 133:1251–1256, 2023.