Creating an Algorithm for Preoperative Cardiac Assessment of Adenotonsillectomy Patients with Obstructive Sleep Apnea

Abstract

Objectives:

Create guidelines in preoperative cardiac workup for obese pediatric patients with obstructive sleep apnea (OSA) undergoing adenotonsillectomy (T&A). Specific objectives include: 1) Correlate body mass index (BMI) with postoperative complications. 2) Correlate BMI with cardiac pathology on preoperative and/or postoperative studies. 3) Determine if severity of OSA based on polysomnography (PSG) testing can predict postoperative complications.

Methods:

We conducted a retrospective chart review of over 110 pediatric patients with a BMI ≥ 25 kg/m² who underwent T&A for OSA at a tertiary care children’s hospital from January 2006 to December 2011, excluding syndromic features or pre-existing cardiopulmonary disorders. Postoperative complications were analyzed in conjunction with BMI and severity of OSA based on polysomnography.

Results:

Preliminary analyses of cardiopulmonary pathology revealed 6 patients with right ventricular hypertrophy or dilation, 18 with tricuspid regurgitation, and 1 with reactive airway disease. There were no severe postoperative complications. Thirty-four patients underwent a polysomnogram with a mean apnea-hypopnea index (AHI) of 37.1 and a mean oxygen nadir of 80.5%. Increasing BMI was significantly correlated with higher AHI (P = 0.01, r = 0.5) but did not predict postoperative complications (P = 0.91). Preoperative oxygen nadir on PSG more closely predicted cardiac pathology, though results did not approach significance (P = 0.15).

Conclusions:

No adverse cardiopulmonary events were experienced by obese pediatric patients undergoing T&A, and hence, current data suggest that preoperative cardiac evaluation for obese children solely for the purpose of undergoing T&A is not routinely warranted.