Clinical outcomes in a high nursing ratio ward setting for children with obstructive sleep apnea at high risk after adenotonsillectomy

BackgroundIn 2012 clinical management of children having adenotonsillectomy (AT) for suspected obstructive sleep apnea (OSA) at our tertiary centre changed based on previous research: children with severe obstructive sleep apnea (OSA) at increased risk of post-operative respiratory adverse events (AE) identified using home overnight oximetry or polysomnography (PSG) were managed post-operatively in a high nurse/patient ratio unit in the ward (high acuity unit, HAU) rather than in the intensive care unit (ICU) as previously.ObjectivesTo examine the post-operative respiratory AE post AT in HAU.MethodsA retrospective audit was performed of children having AT on the HAU list from Oct 2012–Sept 2014, identifying clinical information, pre-operative testing for OSA and post-operative course.Results343 children underwent elective adenotonsillectomy at our tertiary centre in the study period, of whom 79 had surgery on the HAU list (16F; median age 4.2 year (range 1.2–14.7); median weight-for-age centile 77.9% (IQR 44–98.7%)). 75 had moderate/severe OSA by oximetry (n = 44) or PSG (n = 31) criteria. 77 of 79 children had oxygen therapy in the recovery room (median 20 min, IQR 15–40 min). 18 (23%) had at least one AE outside the recovery room, which were observed (n = 2) or treated with oxygen therapy (n = 14) or repositioning (n = 2). Obesity increased the risk of an AE (10/25 obese vs 8/54 non obese, p = 0.01), as did the presence of a major comorbidity (5/9 with comorbidity vs 13/70 without, p = 0.03). There were no admissions from the HAU to ICU. 63 patients (83%) stayed only one night in hospital (median 1 d, range 1–5 d).ConclusionsIn a cohort of children with known moderate-severe OSA, post-operative AE after AT were all managed in the HAU. Post-operative care in HAU provides safe and effective care for high-risk children post-AT, minimizing admissions to ICU.