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Down Syndrome Abstract
of the Month: March 1998

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Postoperative complications after tonsillectomy and adenoidectomy in children with Down syndrome

Goldstein NA; Armfield DR; Kingsley LA; Borland LM; Allen GC; Post JC
Arch Otolaryngol Head Neck Surg 1998 Feb;124(2):171-6

Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, PA, USA.

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OBJECTIVE: To compare the postoperative course and complications after tonsillectomy or tonsillectomy and adenoidectomy in children with Down syndrome (group 1) with the postoperative course and complications in children in a control group (group 2). DESIGN: Retrospective review of medical records for the period January 1, 1986, through March 30, 1996. PATIENTS: The study included 87 children in group 1 and 64 children in group 2 matched for age, sex, and year of surgery. INTERVENTION: Tonsillectomy and adenoidectomy (group 1, 79 children; group 2, 57 children) and tonsillectomy (group 1, 8 children; group 2, 7 children). MAIN OUTCOME MEASURES: Length of hospitalization and postoperative complications.
RESULTS: The length of hospitalization was significantly increased for the children in group 1 (DS) compared with that of children in group 2 (control). Twenty-two children (25%) in group 1 required airway management or observation in the pediatric intensive care unit compared with no children in group 2 who required such care. None of the children in either group required reintubation, continuous positive airway pressure, or tracheotomy. Respiratory complications requiring intervention were 5 times more likely in group 1. The median time until intake of clear liquids and duration of intravenous therapy were significantly increased in group 1 compared with group 2.
CONCLUSIONS: Although tonsillectomy and adenoidectomy can be performed safely in children with Down syndrome, the rate of postoperative respiratory complications is higher and the duration until adequate oral intake is resumed is longer. We therefore recommend that children with Down syndrome be admitted to the hospital overnight after undergoing tonsillectomy and adenoidectomy.

My comments:

My comment: this is one of those times that reading the whole abstract is almost as good as reading the whole study (I edited out the statistical comments from the abstract for brevity's sake).

But this goes along nicely with an earlier paper [Bower, CM and Richmond, D. Tonsillectomy and adenoidectomy in patients with Down syndrome. Int. J. Ped. Otorhinolaryng. 33:141-148, 1995] which stated that significant postoperative apnea was common in children with Down syndrome, and oxygen was needed in over 60% of patients in the study.

Basically, if your child with Down syndrome requires a T/A, don't accept that it's going to automatically be "day surgery," but be aware a longer hospital stay may be needed.
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