Effects of adenotonsillectomy on vaso-occlusive events in sickle cell disease patients

Problem: To evaluate the effect of adenotonsillectomy on sleep apnea, hypoxia, surgical complications, and vaso-occlusive events (VOC) in children with sickle cell disease (SCD). Methods: A retrospective chart review of children with SCD presenting with upper airway obstruction who underwent tonsillectomy or adenotonsillectomy between 1997 and 2003 with the outcome measures of perioperative management, postsurgical complications, surgical length of stay, preop and postop pulse oximetry, major VOC requiring hospitalization, and other hospitalizations. Results: Thirty-two patients were identified with the above criteria (2 tonsillectomy and 30 adenotonsillectomy); 28% had preoperative sleep studies and 6% had postoperative sleep studies. All patients, except 1 who refused for religious reasons, received outpatient preoperative transfusions if hematocrit was <30 (n = 26). The average length of stay for elective surgery was 1.7 days with 17.2% complications (5 desaturations on pulse oximetry, 1 acute chest syndrome, 1 vaso-occlusive pain). Sixty-nine percent were monitored for <24 hours. For 1 and 2 years before and after surgery, there was no significant difference between the number of major VOC (P = 0.5343, P = 1) or hospitalizations (P = 0.7176, P = 0.8487). Outpatient pulse oximetry improved after surgery (93.78% vs 95.50%); however, it did not reach statistical significance (P = 1.061). Conclusion: Children with SCD undergoing adenotonsillectomy can be managed preoperatively with outpatient transfusions. The majority of patients can be monitored for 24 hours, similar to other high-risk populations, but should be carefully assessed for pain control or oxygen desaturation. There is no significant difference in rates of hospitalization or major VOC after tonsillectomy/adenotonsillectomy for upper airway obstruction. Outpatient pulse oximetry improved but was not statistically significant. Significance: This study suggests that adenotonsillectomy may not influence the number of hospitalizations or vaso-occlusive events of SCD patients, though a prospective study is needed to verify these data. However, if adenotonsillectomy is performed, SCD patients can be managed perioperatively similarly to any other high-risk patients. Support: None reported.