The risk of postoperative respiratory complications following adenotonsillar surgery in children with or without obstructive sleep apnea: A systematic review and meta‐analysis

• Published in: Pediatric pulmonology 2022-12, Vol.57 (12), p.2889-2902
• Main Authors: Keserű, Fanni, Sipos, Zoltán, Farkas, Nelli, Hegyi, Péter, Juhász, Márk Félix, Jászai, Viktória Adrienn, Párniczky, Andrea, Benedek, Pálma Edina
• Format: Article
• Language: English
• Subjects: adenoidectomy; Adenoidectomy - adverse effects; Child; Humans; Meta-analysis; obstructive sleep apnea; postoperative complications; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Period; Sleep apnea; Sleep Apnea, Obstructive - complications; Sleep Apnea, Obstructive - epidemiology; Sleep Apnea, Obstructive - surgery; Surgery; Systematic review; tonsillectomy; Tonsillectomy - adverse effects
• ISSN: 8755-6863; 1099-0496
• DOI: 10.1002/ppul.26121

Objectives Obstructive sleep apnea (OSA) appears in 2%–5% of children, with first‐line treatment being adenotonsillar (AT) surgery. Our aim was to examine the risk of postoperative respiratory complications (PoRCs) in non‐OSA and the different OSA severity (mild, moderate, severe) groups. Study Design We conducted a systematic review and meta‐analysis of studies comparing PoRCs following AT surgery in children with and without OSA. Methods Nineteen observational studies were identified with the same search key used in MEDLINE, Embase, and CENTRAL. The connection between PoRCs, the presence and severity of OSA, and additional comorbidities were examined. Odds ratios (OR) were calculated with 95% confidence intervals (CI). Results We found that PoRCs appeared more frequently in moderate (p = 0.048, OR: 1.79, CI [1.004, 3.194]) and severe OSA (p = 0.002, OR: 4.06, CI [1.68, 9.81]) compared to non‐OSA patients. No significant difference was detected in the appearance of major complications (p = 0.200, OR: 2.14, CI [0.67, 6.86]) comparing OSA and non‐OSA populations. No significant difference was observed in comorbidities (p = 0.669, OR: 1.29, CI [0.40, 4.14]) or in the distribution of PoRCs (p = 0.904, OR: 0.94, CI [0.36, 2.45]) between the two groups. Conclusion Uniform guidelines and a revision of postoperative monitoring are called for as children with moderate and severe OSA are more likely to develop PoRCs following AT surgery based on our results, but no significant difference was found in mild OSA. Furthermore, the presence of OSA alone is not associated with an increased risk of developing major complications.