0987 Polysomnography, Comorbidities, and Perioperative Complications in Pediatric Tonsillectomy and Adenoidectomy Article Swipe

Introduction Obstructive sleep apnea (OSA) is the most common indication for adenotonsillectomy (T&A) in the pediatric population. Though polysomnography (PSG) is the gold standard for OSA diagnosis, the role PSG findings, patient comorbidities, and their interactions play in predicting perioperative events remains unclear. The aim of this study is to evaluate the correlation between preoperative PSG findings, patient comorbidities and specific perioperative events. Methods This was a single center retrospective study involving children under 18 years of age undergoing T&A. Bivariate correlation and one/two-way ANOVA analyses were conducted. Results A total of 207 patients were included, with a mean age of 6.32 years, 62.4% male, and 33.3% obese. Elevated AHI correlated with increased ICU time (r=0.310,p< 0.001) and prolonged return to PO intake (r=0.320,p< 0.001), with no significant association with time requiring supplemental O2 (r=0.156,p=0.058) or time requiring mechanical ventilation(r=0.104,p=0.156). Lower SaO2 nadir correlated with increased ICU time, supplemental O2 time, and prolonged return to PO intake (r=-0.322,-0.340,and -0.448, p< 0.001), but not time requiring mechanical ventilation (r=-0.14,p=0.864). ANOVA and descriptive statistics revealed prolonged return to PO intake was associated with the obese BMI class (F(3,140)=2.723,p=0.047), neuromuscular disorders (F(1,142)=7.629,p=0.007), and developmental delay (F(1,142)=7.200,p=0.008). Increased ICU time was associated with neuromuscular disorders (F(1,151)=7.221,p=0.008), cardiac risk factors i.e. structural heart disease (F(1,151)=10.307,p=0.002), and developmental delay (F(1,151)=8.245,p=0.005). Increased supplemental O2 time was associated with neuromuscular disorders (F(1,147)=14.887,p< 0.001), cardiac risk factors (F(1,147)=8.811,p=0.003) and developmental delay (F(1,147)=4.443,p=0.037). Increased time requiring mechanical ventilation was associated with the underweight BMI class (F(3,152)=8.026, p< 0.001). Two-way ANOVA showed elevated BMI class/cardiac risk factors produced a combined effect on time to PO intake (F=4.278,p=0.041), and neuromuscular disorders/cardiac risk factors produced a combined effect on supplemental O2 time (F=4.844,p=0.030). Conclusion Prolonged return to PO intake was significantly associated with elevated AHI, decreased SaO2 nadir, obese BMI class, neuromuscular disorders, and developmental delay. Increased time in the ICU was significantly associated with elevated AHI, decreased SaO2 nadir, neuromuscular disorders, developmental delay, and cardiac risk factors. Prolonged time requiring supplemental O2 was significantly associated with lower SaO2 nadir, neuromuscular disorders, developmental delay, and cardiac risk factors. Support (if any)