ASPO004 - Quickshot: Assessing outcomes after partial and total tonsillectomy for sleep-disordered breathing in children using Clinical Assessment Score-15
Friday, April 29, 2022
1:10 PM – 1:30 PM CT
Location: Landmark C
Jacob G. Mabey, BS1, Candice Kremer, MD1, Emily L. Savoca, MD2, Sarah E. Maurrasse, MD1, Michael S. Weinstock, MD1
1Division of Otolaryngology, Department of Surgery, Yale Univ. Sch. of Med., New Haven, CT, 2Department of Otolaryngology, Children's Hosp. of Pittsburgh, UPMC, Pittsburgh, PA.
Medical Student Department of Surgery, Division of Otolaryngology -- Head and Neck Surgery, Yale School of Medicine New Haven, Connecticut
Introduction: The Clinical Assessment Score-15 (CAS-15) is an office-based tool for assessing the risk of sleep disordered breathing (SDB), a relatively common condition in the pediatric population. Change in CAS-15 following total extracapsular tonsillectomy (ET) has been shown to have a large effect size, but it is unclear how it varies following partial intracapsular tonsillectomy (IT). Thus, the objective of the present study is to assess the change in CAS-15 score following IT and how this compares to change after ET.
Methods: Children ages 2-18 undergoing IT (N=16) or ET (N=6) with or without adenoidectomy for SDB completed the CAS-15 before surgery and at their post-operative follow-up visit. Changes in CAS-15 score were assessed by paired t-test. The mean difference in CAS-15 change between IT and ET was evaluated by unpaired t-test for unequal variances. Differences in participant characteristics were determined via unpaired t-test for unequal variances.
Results: Participants undergoing IT did not differ significantly than those undergoing ET with regards to age, sex, BMI percentile, or pre-op CAS-15 score or tonsil size (p>0.05). The mean follow-up after surgery was 7.9 (IT) and 4.0 (ET) weeks (p>0.05). CAS-15 score improved significantly following IT (42.8±12.3 vs. 9.4±5.6, p<0.0001) and ET (45.5±15.6 vs. 6.0±5.0, p<0.01). The decrease in CAS-15 for IT did not differ from ET (33.3±11.8 vs. 39.5±16.6, p=0.43).
Conclusion: CAS-15 decreases drastically following IT and ET, indicating significant improvement of SDB symptoms. Because the change in CAS-15 after IT was similar to ET, IT may be preferred due to the decreased morbidity of the procedure. Given the cost, time required, inconvenience, and other limitations of overnight polysomnography (PSG), the gold standard method of diagnosing SDB, CAS-15 may be a suitable replacement or adjunct for the assessment of SDB following IT in addition to ET.