Adenotonsillectomy for Paediatric Sleep Disordered Breathing – Post Surgery Placement and Outcome

Abstract

Adenotonsillectomy (AT) is the treatment of choice for children with sleep disordered breathing (SDB) caused by adenotonsillar hypertrophy. However, there is an increased risk of post operative complications among those with identified risk factors. Therefore, they are electively admitted to critical care wards after surgery. Unfortunately, due to limited resources and availability of beds in critical care wards, the cancellation rate for AT can be significant at some hospitals. It is becoming more difficult to satisfy the heightened demand for close monitoring post AT due to the increasing number of obese children and surge of SDB cases. Delaying surgery may indirectly worsen the child’s co-morbidities. Thus, it is vital to have a flowchart for post AT placement, which can be practical to many centres facing similar logistics concerns. This retrospective chart review done over 6 months included all paediatric patients who had AT for SDB at our centre. The objectives of this review were to identify factors contributing to elective admission to the paediatric intensive care unit (PICU)/paediatric high dependency unit (PHDU) following AT among patients with paediatric SDB, recognize association between obesity and PICU/PHDU admission as well as find the association between severity of allergic rhinitis with outcome post AT. We aim to have a flow chart for preoperative planning of post-surgery nursing placement among patients with SDB who are managed with AT at this centre. Obese patients without significant co-morbidities can be nursed in the general ward, the real admission rate to PHDU/PICU is lesser compared to that was planned pre-operatively and children with moderate- severe AR tend to have residual snoring post AT. A flow chart for preoperative planning of post-surgery nursing placement among patients with SDB can help to reduce unnecessary booking and admission to critical care wards, decreasing the waiting time for AT and backlog of cases at public hospitals.