Abstract
Objective: In 2008, an expert UK panel produced a consensus statement highlighting factors putting children at additional risk of having respiratory complications following adenotonsillectomy for sleep related breathing disorders. This audit, performed at a pediatric teaching hospital, assessed whether at-risk children indicated by the guidelines were having appropriate preoperative investigations.
Method: A retrospective study conducted in the Royal Alexandra Children’s Hospital in Brighton over a 6-month period. A total of 49 children having elective day case adenotonsillectomy fulfilled inclusion criteria. Patient notes were analyzed for demographics and past medical history to see if they fit the consensus criteria to undergo sleep studies preoperatively.
Results: The audit highlighted that the common indications putting children in the high risk group were weight (<15 kg), age (<2) and significant co-morbidity. Despite 49% fulfilling criteria to have pre-operative sleep studies, only 20% of this high risk group were investigated pre-operatively. The most common complication was postoperative desaturations. Overall 10% of the audit population developed postop complications requiring enhanced level of care. 60% of these complications were in high risk patients who did not have pre-op sleep studies and pre-booked high dependency unit (HDU) provision. A total of 8 days of unplanned HDU care was needed.
Conclusion: Standards of preoperative respiratory investigations were not being met, with children being listed for adenotonsillectomy without appropriate risk stratification. Information bulletins were disseminated across relevant specialties and risk chart posters were introduced to ENT consultation rooms. A repeat audit cycle will be completed in 6 months.
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