Pediatric Obstructive Sleep Apnea (POSA) is characterized by episodes of nocturnal intermittent hypoxia. Untreated POSA can lead to a cascade of lifelong health issues. Tonsillectomy/adenoidectomy (T/A) is frequently used to address POSA. T/A carries acute risks in the postoperative phase of care and POSA patients can be a true challenge for healthcare providers. This study focuses on the significant issue of managing the pain of POSA patients following a corrective tonsillectomy and adenoidectomy surgery (T/A). The objective of this study was to describe the population undergoing corrective T/A, to explore the postoperative pain experience of POSA patients and compare it with that of other patients following corrective T/A.
The objectives of this study were met through a retrospective chart review of 499 POSA and nonPOSA patients aged 3-14 years who had a corrective T/A between May 1, 2017 and May 1, 2023 at Johns Hopkins Hospital in Baltimore, Maryland. T/A surgeries were performed for POSA on 339 children and for other reasons (nonPOSA) on 160 patients. A descriptive analysis of the population was completed. The objective of exploring the postoperative pain experience was met through a comparative analysis between POSA and nonPOSA patients during their hospital encounter for T/A surgery.
The results showed a significant difference in the demographics and health characteristics between the POSA and nonPOSA patients. Additionally, the results showed that POSA patients spent more time in the operating room and the postoperative phase of care and received significantly less weight-based morphine milligram equivalent and have significantly lower postoperative pain scores than nonPOSA patients. POSA was an independent predictor of the dosage of opioid medication used after controlling demographic, other health, and surgical predictors. Interventions during the postoperative phase were more frequent in POSA than nonPOSA T/A patients. Maximum, first, last, and mean postoperative pain scores did not differ between POSA and nonPOSA T/A patients. POSA was not an independent predictor of pain in the postoperative phase after controlling for operative medications, postoperative medications, and medical, health, and surgical characteristics. Additional research on pain and medication patterns in POSA T/A patients is warranted.