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Factors Predictive of Adverse Postoperative Events Following Tonsillectomy

Subramanyam, Rajeev
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1384869860

Abstract Details

2013, MS, University of Cincinnati, Medicine: Clinical and Translational Research.
Background: Tonsillectomy is the second most common surgery done in children in the United States. In spite of more than 500,000 surgeries done every year there is no evidence for postoperative disposition of patients following tonsillectomy. Our data shows that up to 10% of patients end up having unanticipated emergency room (ER) visits after tonsillectomy. The primary aim of the study is to predict the risk factors for the occurrence of unanticipated ER visits at 3-days and 3-weeks (after 3-days) following tonsillectomy. Methods: In this single-center prospective observational cohort study, all consenting patients < 17 years of age presenting for tonsillectomy with or without adenoidectomy were included. After obtaining the approval of the Institutional Review Board, patients undergoing tonsillectomy were recruited from the weekly operating room schedule, using a simple random sampling technique. Patients belonging to American Society of Anesthesiology physical status 4 and 5, undergoing any additional procedures with the adenotonsillectomy, and those who refused to consent were excluded. The preoperative, intraoperative, postoperative data on patient related, health system related, and anesthesia related factors were used as the predictive variables. The primary outcomes of interest were the prediction of risk factors for the occurrence of unanticipated ER visits at3-days and 3-weeks after tonsillectomy. Secondary outcomes were complications in post anesthesia care unit. The outcomes were assessed by a postoperative telephone survey at 24 hours and at 3-weeks post discharge and also by the electronic record. Reasons for the occurrence of adverse events were noted. Families were compensated $10 for their participation in the survey. Using REDCap database bolstered data accuracy. Univariate analysis was done and variable with a p value of <0.24 was included in the first model. Variables with a p value of <0.05 with the first model was included in the final model. Goodness of fit was tested and c statistic obtained. Statistical analysis was done using SAS software. Results: Data on 469 patients < 17 year old who underwent tonsillectomy were available for analysis. The mean age was 6.5 years and body mass index was 18.13. Pediatric sleep questionnaire was completed in all patients and sleep apnea was present in 56.5%. Multivariate logistic regression identified preoperative diastolic blood pressure (Odds Ratio (OR) 0.925; p-value=0.0097), intraoperative dexamethasone (OR 1.246, p-value=0.0078), preoperative neurologic comorbidity (OR 5.101, p-value=0.0561), presence of failure to thrive (OR 1.090, p-value=0.0421) as risk factors for unanticipated ER visits at3-days and preoperative systolic blood pressure (OR 0.939; p-value=0.005), intraoperative dexamethasone (OR 1.207, p-value=0.0058), use of home medications (OR 3.503; p-value=0.0148), presence of upper respiratory infections (OR 4.173; p-value=0.0098) at 3-weeks. Both the model had adequate goodness of fit with the variables. Conclusions: Our study identified preoperative blood pressure, intraoperative dexamethasone, preexisting conditions like upper respiratory infection, neurologic comorbidity, failure to thrive, and use of home medications as risk factors that predict unanticipated ER visits following tonsillectomy. These important and easily measurable variables provide valuable information for optimal management of patients undergoing tonsillectomy.
Erin Nicole Haynes, Ph.D. (Committee Chair)
Monir Hossain, Ph.D. (Committee Member)
Anna M. Varughese, M.D. (Committee Member)
51 p.
Surgery
Tonsillectomy; Adverse events; Children; emergency room visits; prediction model; anesthesia

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Citations

  • Subramanyam, R. (2013). Factors Predictive of Adverse Postoperative Events Following Tonsillectomy [Master's thesis, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1384869860

    APA Style (7th edition)

  • Subramanyam, Rajeev. Factors Predictive of Adverse Postoperative Events Following Tonsillectomy. 2013. University of Cincinnati, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1384869860.

    MLA Style (8th edition)

  • Subramanyam, Rajeev. "Factors Predictive of Adverse Postoperative Events Following Tonsillectomy." Master's thesis, University of Cincinnati, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1384869860

    Chicago Manual of Style (17th edition)

ucin1384869860
379
© 2013, all rights reserved.
This open access ETD is published by University of Cincinnati and OhioLINK.