Is routine pre-operative cardiac evaluation necessary in obese children undergoing adenotonsillectomy for OSA?

BackgroundAdenotonsillectomy (T&A) is a common surgery performed for obstructive sleep apnea (OSA) in children. Obese children are at increased risk for OSA, but are also at increased risk for cardiovascular changes that might heighten their risk of undergoing a general anesthetic. There is currently no standard of care recommendation for cardiac workup prior to T&A.PurposeTo ascertain whether a preoperative cardiac workup is predictive of postoperative complications in obese children undergoing T&A for OSA.DesignRetrospective cohort review.Material and Methods241 children with BMI ≥ 25 kg/m2 underwent T&A for OSA. This cohort was divided into three groups — those who had no preoperative cardiac evaluation, those who had a preoperative cardiac evaluation but no significant findings and those who had a preoperative cardiac evaluation with at least one significant finding. Postoperative cardiac-related complications were compared between the three groups.ResultsThere were significantly more postoperative complications in Group 3, the group with findings on preoperative cardiac evaluation. However, these were heavily weighted toward “hospital stay > 24 hours” without clear cardiac sequelae. Notably there were no incidents of pulmonary edema, re-intubation postoperatively or death.ConclusionIn obese children undergoing T&A at a tertiary care center, a preoperative cardiac workup was not shown to be beneficial in predicting postoperative complications.