May 16, 2006

In-out tonsillectomy seen too risky for young kids

NEW YORK (Reuters Health) - Children younger than 3 years
of age who have their adenoids and tonsils removed as a remedy
for sleep-disordered breathing are at greater risk for
respiratory complications than older kids and, therefore,
should probably be hospitalized for the procedure, according to
a new report.

Advances in anesthesia and surgical techniques have led
third-party payers to pressure doctors to perform
adenotonsillectomy as an outpatient procedure, say Dr. Maninder
Kalra and colleagues, from Cincinnati Children's Hospital
Medical Center in Ohio.

To investigate any downside to this approach, the
researchers analyzed data on all children younger than 6 years
of age who underwent adenotonsillectomy for obstructive sleep
apnea at their center between June 1999 and May 2001.

With obstructive sleep apnea, breathing stops briefly, but
many times an hour, during sleep. This can lead to daytime
sleepiness and ultimately to high blood pressure.

The team's findings appear in the Archives of
Otolaryngology -- Head and Neck Surgery. Of the 2315 children
included in the study, 149 (6.4 percent) developed respiratory
complications after the surgery, the investigators report.

Children younger than 3 years of age experienced twice the
rate of respiratory complications compared with their older
counterparts -- 9.8 percent vs. 4.9 percent.

"Our results are in agreement with previous studies that
report an increased risk for postoperative respiratory
complications in children younger than 3 years," the
investigators state.

The findings, they say, provide "additional evidence" to
justify guidelines recommending "inpatient adenotonsillectomy
in patients younger than 3 years."

SOURCE: Archives of Otolaryngology -- Head and Neck
Surgery, May 2006.