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Nira A. Goldstein, MD; Derek R. Armfield, MD; Lawrence A. Kingsley, DrPH; Lawrence M. Borland, MD; Gregory C. Allen, MD; J. Christopher Post, MD

Arch Otolaryngol Head Neck Surg. 1998;124:171-176.

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.

Setting  Tertiary care children's hospital.

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 compared with that of children in group 2 (1.6 vs 0.80 days; P=.001, Mann-Whitney U test). 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 (P<.001, Fisher exact test). 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 (22 [25] vs 3 [5]; P<.001, Fisher exact test). The median time until intake of clear liquids and duration of intravenous therapy were significantly increased in group 1 compared with group 2 (5.0 vs 4.0 hours, P=.03; 23.5 vs 16.0 hours, P=.001, respectively; Mann-Whitney U test).

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.

From the Departments of Pediatric Otolaryngology (Drs Goldstein, Armfield, Allen, and Post) and Anesthesiology (Dr Borland), Children's Hospital of Pittsburgh, and the Departments of Otolaryngology (Drs Goldstein, Armfield, Allen, and Post), Infectious Diseases and Microbiology/ Epidemiology, Graduate School of Public Health (Dr Kingsley), and Anesthesiology (Dr Borland), University of Pittsburgh School of Medicine, Pittsburgh, Pa. Dr Post is now with the Department of Pediatric Otolaryngology, Allegheny General Hospital, Pittsburgh.

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