Early Surgery Cuts Healthcare Use in Pediatric Sleep Apnea

TOPLINE:

Early adenotonsillectomy (AT) in children with mild sleep-disordered breathing (SDB) reduced total healthcare encounters by 32% and prescription medications by 48% over 12 months compared with watchful waiting.

METHODOLOGY:

• Researchers conducted a 12-month, parallel-arm randomized clinical trial at tertiary care centers in the United States from 2016 to 2022, comparing early AT vs watchful waiting with supportive care.
• Participants included 381 children aged 3-13 years with mild SDB, tonsillar hypertrophy grade ≥ 2, BMI z score < 3, and referral from clinicians within the local electronic medical record system.
• Analysis focused on total healthcare encounters and prescriptions over 12 months post-randomization, excluding encounters within 28 days post-surgery to avoid capturing immediate post-operative care.
• Health care utilization (HCU) data were extracted from electronic medical records, with encounters and prescriptions tracked between day 1 post-randomization and day 365.

TAKEAWAY:

• Early AT resulted in a 32% reduction in total healthcare encounters (mean difference, −1.25; 95% CI, −1.96 to −0.53) and a 48% reduction in prescriptions (mean difference, −2.53; 95% CI, −4.12 to −0.94).
• The reduction in encounters was primarily driven by fewer office visits (mean difference, −0.77 per participant per year) and outpatient procedures (mean difference, −0.44 per participant per year).
• Prescription reductions were most notable in analgesics/anesthetics (mean difference, −0.81), dermatological medications (mean difference, −0.54), and respiratory medications including corticosteroids (mean difference, −0.50).
• The effect of surgery on healthcare encounters was more pronounced in children older than 5 years (mean difference, −1.53; 95% CI, −2.51 to −0.56) compared with those ≤ 5 years (mean difference, −0.94; 95% CI, −2.02 to 0.13).

IN PRACTICE:

“The medication category with the greatest difference between surgery and no-surgery was analgesics/anesthetics, even after excluding prescriptions written during the postoperative period. This is a novel finding but is consistent with multiple studies that have demonstrated insufficient sleep influences nociceptive processing,” wrote the authors of the study. An accompanying editorial noted that “the finding of substantial reduction in HCU, even with mild SDB, suggests an even greater downstream impact of AT that is generalizable beyond children with severe OSA. It is also worth considering the unmeasured impacts to caregivers and families where the decreased need for outpatient visits or medications translates into fewer days of missed school or time off work and less out-of-pocket costs.”

SOURCE:

The study was led by Jessie P Bakker, PhD, Brigham and Women’s Hospital in Boston. It was published online on March 17 in JAMA Pediatrics. The accompanying editorial was written by Derek J. Lam, MD, MPH, Oregon Health and Science University, Portland, and published online in JAMA Otolaryngology-Head and Neck Surgery on March 17. 

LIMITATIONS:

According to the authors, the fragmented nature of the United States healthcare system resulted in inconsistent capture of encounters and prescriptions occurring outside each site’s medical record system. Additionally, prescription data reflected written prescriptions rather than those actually filled, likely overestimating actual consumption. The study’s recruitment through tertiary care centers may limit generalizability to community-based practices.

DISCLOSURES:

The study was supported by research contracts from the National Institute of Heart, Lung and Blood Institute of the National Institutes of Health. Jessie P Bakker, PhD, reported employee ownership of shares from Philips and Signifier Medical Technologies and consulting fees from Koneksa Health and Apnimed outside the submitted work. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.