Factors Associated With Postadenotonsillectomy Unexpected Admissions in Children

Study Type: Single centre prospective cohort observational study conducted at Cincinnati Children’s Hospital analysing factors associated with post-adenotonsillectomy unexpected admissions in children.

Method: Excluded patients having multiple procedures or ASA 4/5 patients. The primary endpoint was unexpected admissions up to 3 weeks postoperatively and the secondary endpoint was unexpected admissions up to 3 days postoperatively. Both endpoints were determined by a mixture of a phone call at the endpoint time and data obtained from electronic medical records. Data was also collected on additional preoperative, intraoperative and postoperative characteristics or interventions and there was statistical analysis to determine the effects of these on the endpoints. The total number of children analysed were 2375.

Findings: At 3 weeks, 7.9% of patients had unexpected admissions and at 3 days 5.9% had unexpected admissions. Factors that were associated with increased unexpected admissions by 3 weeks were immediate presurgery medications (albuterol or midazolam, OR 2.3), long term home medications (OR 1.4) and neurological comorbidities (OR 1.8), whilst perioperative paracetamol (OR 0.6) and ENT comorbidities (OR 0.6) were associated with decreased admissions. Factors associated with increased unexpected admission at 3 days were IV induction vs inhalational induction (OR 1.8), dermatology comorbidities (OR 1.8) and URTIs (OR 1.7).

Commentary: This was a well-designed cohort study with a clinically relevant outcome that is applicable to paediatric populations in a multitude of settings. Limitations of the study include the possibility of recall bias from the phone calls of data collection. As it was an observational cohort study, there was no randomisation or use of controls in the study design. The authors also acknowledge there was no external validation performed.

In conclusion, this cohort study had some interesting clinically significant results showing the association between a number of factors such as pre-surgery medication, long term home medication and neurological comorbidities with unexpected admissions after tonsillectomies at 3 weeks, but also a reduced number of admissions with use of paracetamol and presence of ENT comorbidities. It could potentially help with stratifying patient risk for unexpected post-operative admissions and identifying ways to mitigate the risk.

Reviewed by Dr Patrick Rubie