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Horwood L, Nguyen LHP, Brown K, Paci P, Constantin E. African American Ethnicity as a Risk Factor for Respiratory Complications Following Adenotonsillectomy. JAMA Otolaryngol Head Neck Surg. 2013;139(2):147–152. doi:10.1001/jamaoto.2013.1321
Author Affiliations: Departments of Pediatrics (Ms Horwood and Dr Constantin), Otolaryngology (Dr Nguyen), and Anesthesia (Dr Brown), Montreal Children's Hospital, McGill University Health Centre, and McGill University (Mr Paci), Montreal, Quebec, Canada.
Objective To evaluate whether African American ethnicity is a risk factor for major respiratory complications following adenotonsillectomy (T&A).
Design Retrospective cohort study.
Setting A Canadian tertiary care center.
Patients Children aged 0 to 18 years who underwent T&A at our institution from 2002 to 2006 with planned or unplanned postoperative admissions.
Main Outcome Measures We evaluated the association between ethnicity and our main outcome measure, major perioperative respiratory complications of T&A. Parental report of ethnicity was available for 23% of our cohort. At our institution, African American children undergo a routine preoperative sickle cell test (TestSC). Data on TestSC were included for all children. We established that having a TestSC was an accurate proxy for African American ethnicity (sensitivity, 96%; specificity, 93%; positive predictive value, 77%; negative predictive value, 99%).
Results Seventy-four of 594 children experienced major respiratory complications (12.5%). Compared with children who did not have major respiratory complications, those who did had a TestSC (P = .01), were 2 years or younger (P < .001) and had lower weight-for-age z scores (P = .04), moderate to severe obstructive sleep apnea (P = .003), and comorbidities (P < .001). When controlling for these variables in a multivariate analysis, children of African American ethnicity (TestSC used as a proxy) were at higher risk of having major perioperative respiratory complications (adjusted odds ratio, 1.82 [95% CI 1.05-3.14]) (P = .003).
Conclusions Children of African American ethnicity (TestSC used as a proxy) are nearly twice as likely to experience major respiratory complications related to T&A. Ethnicity may be an additional independent risk factor for clinicians to consider when planning for T&A.
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