Is Surgical Treatment for Obstructive Sleep Apnea in Infants and Toddlers Safe? A Retrospective Comparative Analysis

OBJECTIVE: To assess if surgery for Obstructive Sleep Apnea Disorder (OSAD) is safe for infants and toddlers. METHODS: Retrospective cohort study of paediatric patients undergoing OSA surgery; partial or complete tonsillectomy with adenoidectomy, tonsillectomy without adenoidectomy and adenoidectomy. Patients were divided into three groups: infants (≤ 1 year), toddlers (1-2 years) and control (children ≥ 2 years). The study measured outcomes such as paediatric intensive care unit (PICU) admissions, length of hospital stay (LOS), emergency room (ER) visits within 2 weeks of surgery, fever, dehydration, bleeding and the need for reoperation. RESULTS: A total of 419 paediatric patients were included: 61 infants (14.5%), 147 toddlers (35.1%) and 211 controls (50.4%). Adenoidectomy was the most common procedure for infants (75%), followed by toddlers (52%) and controls (27%). The LOS was significantly longer in the infant group (p < 0.001). PICU admissions were higher in infants compared to the control group (p < 0.001). However, after adjusting for the type of surgery, no statistical difference was found. Additionally, there were no significant differences in the relative risk of ER visits, fever, or bleeding between the groups. A total of 60 patients (14.3%) in the cohort underwent reoperations, with higher rates in toddlers compared to infants and controls (25.2%, 16.4% and 6.2%, respectively, p < 0.001). The most common revision surgery for the control group was adenoidectomy (8/13, 61.5%), while for toddlers and infants, the most common revision surgery was adenoidectomy + tonsillectomy (22/37, 59.45% and 5/10, 50%, respectively). However, after adjusting for the type of surgery, no statistical difference was found. CONCLUSION: OSA surgery in children aged ≤ 2 years is generally safe but carries risks, including longer hospital stays. The higher rate of reoperations in this age group highlights the need for longer follow-up and parental education about the recurrence of clinical symptoms.