(1307) Clinical Outcomes in Obese Children Without Routine Preoperative Polysomnography Following Adenotonsillectomy

Introduction: Clinical guidelines recommend preoperative polysomnogram (PSG) for obese children undergoing adenotonsillectomy (T&A) for obstructive sleep apnea (OSA) due to increased risk for perioperative respiratory complications. However, PSG is not always obtained due to access limitations or institutional practice. This study evaluates perioperative management and post-discharge outcomes in obese pediatric patients undergoing T&A with and without preoperative PSG to assess whether selective omission of PSG is associated with adverse outcomes or downstream healthcare utilization.

Methods: We performed a single-institution, retrospective cohort study of 408 obese pediatric patients undergoing T&A between 2024-2025. Patients were divided into groups with and without a PSG then case-controlled for BMI severity class, syndromic status, and comorbidities. The main outcomes measured included the use of postoperative supplemental oxygen, readmission within 30 days, refractory OSA symptoms, and the need for additional interventions.

Results: A total of 152 patients were compared. Postoperative oxygen requirement was higher in the PSG group with 14% requiring oxygen
compared to 2.6% without PSG (p = 0.03). There was no significant difference between groups for ED visits or readmissions. Only 5.3% of patients without PSG had persistent OSA symptoms following T&A versus 18% of patients with PSG (p=0.004). No patients without preoperative PSG required additional interventions whereas 12% and 6.6% of patients with preoperative PSG required CPAP and additional surgeries, respectively (p=0.006).

Conclusions: Contrary to our hypothesis, selective omission of preoperative PSG was not associated with increased perioperative or postoperative complications, even with risk-matching. Children with preoperative PSG had higher rates of persistent OSA and subsequent interventions, supporting selective rather than routine use of PSG in obese children. These findings highlight the need for improved methods to identify factors driving persistent disease, which may improve patient selection.