The Effect of Social Vulnerability on Perioperative Tonsillectomy Outcomes in Children

Abstract

Objective: To determine if children with greater social vulnerability are more likely to experience a prolonged oxygen requirement (POR) following adenotonsillectomy to inform the need for overnight monitoring prior to discharge.

Methods: A previously published prospective study assessing children observed overnight following adenotonsillectomy for obstructive sleep-disordered breathing was reanalyzed including social vulnerability index (SVI). The outcome was POR beyond 3 h following extubation. Logistic regression was used to assess the association of SVI components with POR. SVI components were assessed as quartiles of cohort values. Final adjusted models included race, asthma, Down syndrome, and pre-operative SpO₂.

Results: A total of 462 children had SVI data available and were included. 354 (76.6%) were > = 3 years of age. Overall, 351 (76%) did not have a POR. The median overall SVI percentile was 26.5 (Q1 10.4, Q3 60.1). When categorized by SVI quartiles, there was a statistically significant difference with POR for overall SVI percentile (p = 0.007), SVI household composition percentile (p = 0.033), and median SVI housing/transportation percentile (p = 0.005). Individuals with an overall SVI in the 4th quartile (greatest vulnerability) were 2.63 times more likely to experience a POR than those in the 1st quartile (lowest social vulnerability) in adjusted logistic regression (95% OR CI 1.23-5.62; p = 0.01).

Conclusions: There is a significant association between greater neighborhood-level social vulnerability and a POR following adenotonsillectomy. We propose that a child's SVI be considered when planning for the perioperative course following adenotonsillectomy.

Level of evidence: 3 Laryngoscope, 134:2449-2454, 2024.

Keywords: child; complication; health disparities; obstructive sleep apnea; obstructive sleep‐disordered breathing; social vulnerability; tonsillectomy.