Day case adenotonsillectomy for paediatric obstructive sleep apnoea: a review of the evidence.

BACKGROUND: Tonsillectomy and adenoidectomy are two of the most commonly performed procedures by otolaryngologist, especially in the paediatric population. Most common indications for adenotonsillectomy in the paediatric population include recurrent tonsillitis, otitis media (glue ear) and obstructive sleep apnoea (OSA). Whilst adenotonsillectomy is routinely performed as a day case for recurrent tonsillitis, many surgeons advocate an overnight stay for patients for OSA. The practice of keeping these patients in overnight for saturation monitoring is widely undertaken. There has been some dispute as to whether this is required.

OBJECTIVE OF REVIEW: This review sets out to consider the evidence supporting the safety of day case adenotonsillectomies for paediatric obstructive sleep apnoea (OSA).

SEARCH STRATEGY: The available literature between 2004 and 2017 was reviewed via searches on Pubmed, Medline, EMBASE and Google Scholar. The search terms used were: Adenotonsillectomy, day case, paediatric, obstructive sleep apnoea, and complications.

RESULTS: A literature search identified 31 articles that were relevant to our review. After screening six articles were appropriate for inclusion in this review paper, all were retrospective reviews of case notes. 1463 children out of 1992 (including at least 207 children with comorbidities who were kept overnight) children had day case adenotonsillectomy for obstructive sleep apnoea. Tonsillectomy techniques were not discussed in any of the papers.

CONCLUSION: Day case adenotonsillectomy for children between 3 and 17 years who appears to be a safe option with a growing body of evidence. Large randomised control trials would likely add weight to this conclusion and help change the mind-set of clinicians.