• Michael E McCormick, Anthony Sheyn, Michael Haupert, Ronald Thomas, and Adam J Folbe.
• Department of Otolaryngology-Head & Neck Surgery, Wayne State University School of Medicine, Detroit, MI, United States. Michaelemccormick@gmail.com
• Int. J. Pediatr. Otorhinolaryngol. 2011 Nov 1;75(11):1391-4.

ObjectivesTo identify risk factors for complications in the first 24h after surgery in the young (<4 years old) adenotonsillectomy patient.MethodsA retrospective chart review was performed at a tertiary care children's hospital. Consecutive records of all children of age 3 years and younger undergoing adenotonsillectomy over a 5 year period were included in the study. The main outcomes measured were total and airway complications occurring on post-operative days 0-1.Results993 patients were included in the study. The mean age was 2.94 years old. Witnessed apneas (74.1%) and snoring (59.2%) were the most frequent pre-operative symptoms. 700 children were admitted with a mean length-of-stay of 1.22 days (0-9 days) and a mean time-to-oral intake of 0.28 days (0-4 days) among those patients admitted. The total number of complications was 102 in 98 patients (9.9%). There were 35 complications on post-operative days (POD) 0-1 (3.5%), and 23 of those were airway-related (2.3%). With regard to all complications on POD 0-1, significant predictors were nasal obstruction, gastroesophageal reflux disease, prematurity and a history of cardiovascular anomalies. Significant predictors of airway complications on POD 0-1 were younger age (1-2 years old), larger adenoid size, nasal obstruction, and a history of cardiovascular anomalies.ConclusionsKnowing the stated risk factors for complications in the early post-operative period after adenotonsillectomy in the younger pediatric patient can help select certain patients for closer monitoring. Specifically, children aged 1-2 years old with a history of nasal obstruction from large adenoids, gastroesophageal reflux disease, prematurity, and/or cardiovascular anomalies appear to be at higher risk for early complications and should warrant closer observation.Copyright © 2011. Published by Elsevier Ireland Ltd.

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