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.