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array:1 [ "es" => array:1 [ "titulo" => "Dermoides nasales pediátricos: nuestra experiencia" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 718 "Ancho" => 1250 "Tamanyo" => 93570 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Clinical photograph and CT scan showing nasoglabellar dermoid.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ravi Meher, Avani Jain, Ishwar Singh, Nivea Singh, Raman Sharma" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Ravi" "apellidos" => "Meher" ] 1 => array:2 [ "nombre" => "Avani" "apellidos" => 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Genoveva del-Río Camacho" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Jesús" "apellidos" => "Rodríguez-Catalán" "email" => array:1 [ 0 => "jesusrodricatalan@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "José" "apellidos" => "Fernádez-Cantalejo Padial" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Paula" "apellidos" => "Rodríguez Rodríguez" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 3 => array:3 [ "nombre" => "Fernando" "apellidos" => "González Galán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "Genoveva" "apellidos" => "del-Río Camacho" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Pediatría, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Unidad Multidisciplinar del Sueño, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Otorrinolaringología, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Complicaciones postoperatorias tras adenoamigdalectomía en 2 grupos de pacientes pediátricos: síndrome de apnea-hipopnea del sueño e infecciones de repetición" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 946 "Ancho" => 1419 "Tamanyo" => 70978 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Complications in the whole sample (absolute values) Gr.1.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction and Objectives</span><p id="par0005" class="elsevierStylePara elsevierViewall">Recently, due to the development of techniques validated for the study of sleep (polygraphy and polysomnography) an increase in confirmed diagnoses of obstructive sleep apnoea syndrome (OSAS) in paediatric ages has taken place. This has involved an increase in adenotonsillectomies performed for this reason,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> rather than surgery for recurrent tonsillitis, which up until a few years ago was the most common indication for this operation.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Two years ago, in this same centre a study was conducted which was also published in this journal<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> to assess whether further complications occurred in patients with severe OSAS compared to patients with mild/moderate OSAS and/or recurrent tonsillitis, and also to detect the place where these adverse events most frequently took place (in the operating theatre, in the post-anaesthesia recovery unit [PARU],during hospital stay or in a paediatric intensive care unit [PICU]). This study concluded that adenotonsillectomy is a safe technique which does not involve complications a posteriori in patients with serious comorbidities (polymalformative syndromes or neuromuscular diseases), over 2 years of age and without any incidences immediately postoperative, with all of these factors being independent from the reason for the operation. It is true that the severe OSAS group suffered from a higher rate of respiratory complications, but when they did occur it was immediate, in the operating theatre or the PARU.</p><p id="par0015" class="elsevierStylePara elsevierViewall">These patients may therefore be sent to a ward after the operation and do not need to stay in the UCIP,<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–6</span></a> as was the case according to internal protocol for patients with severe OSAS grave until the study was conducted.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The aim of this study was to follow the same line of research and reanalyse the situation 2 years after the change in protocol. Therefore not all children operated on for severe OSAS were routinely put into the UCIP (with a total of 5 years of analysis) to confirm that the postoperative complications in adenotonsillectomies continue to be uncommon and similar in both groups of paediatric patients (OSAS compared with recurrent tonsillitis). A secondary objective was to increase the sample size, to check whether any conclusion could be reached in the group under 3 years of age, because its size was too small to do this in the previous study.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">A retrospective, observational study was conducted by the paediatric services, a multidisciplinary sleep and ENT unit, reviewing the paediatric patients operated on for adenotonsillectomy, during a total period of 5 years (between May 2010 and May 2015).</p><p id="par0030" class="elsevierStylePara elsevierViewall">Data were collected from all children who underwent adenotonsillectomy during this time interval in our centre, excluding those with clinical suspicion of OSAS, but without polygraphic or polysomnographic confirmation and also those with syndromes, neuromuscular diseases and /or craniofacial malformations.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The variables analysed were: sex, age of the patient and anthropometric data (weight, height and body mass index [BMI]) at the time of surgery, the reason for the operation, the presence or absence of complications and if there were any, the type of complication (postsurgical bleeding, changes in respiration, digestive intolerance) and place where they occurred (operating theatre, post-anaesthesia recover unit, and ward or UCIP).</p><p id="par0040" class="elsevierStylePara elsevierViewall">Regarding age, this was collected at the time of surgery, calculating the mean age of the patients in both groups and dividing patients into 3 age groups: under 3 years of age, between 3 and 5 years of age and over 5 years of age, so that the risk of complications in accordance with age could be stratified.</p><p id="par0045" class="elsevierStylePara elsevierViewall">With regard to anthropometric data the patients were divided according to the Z-score for BMI into low weight(BMI under –2 standard deviations), normal weight (BMI between –2 y<span class="elsevierStyleHsp" style=""></span>+2 standard deviations) or overweight (BMI above<span class="elsevierStyleHsp" style=""></span>+2 standard deviations), to confirm whether their prior nutritional status was related to a higher number of complications or not.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Regarding the reason for surgery, the patients were finally divided into 4 groups when data was collected: recurrent tonsillitis and mild, moderate or severe OSAS, depending on the result of the diagnostic tests (nocturnal sleep study or respiratory polygraphy).</p><p id="par0055" class="elsevierStylePara elsevierViewall">The sleep study was performed in the multidisciplinary sleep unit, with the Somnoscreen system by Sanro, for a single night. In this study continuous EEG monitoring was included (C4-A1, C3-A2, F4-A1, F3-A2, O1-A2), EOG, submental EMG and in bilateral tibialis anterior muscle, thermistor and cannula to measure nasal and mouth air flows, chest and abdominal effort, transcutaneous pulse oximetry, ECG and video recording. The polygraphic study was performed at night in the patient’s home (always from 2 years upwards), with the T3 Cardinal Health system, and included transcutaneous pulse oximetry, nasal airflow cannulas, position microphone and sensors and chest and abdominal effort.</p><p id="par0060" class="elsevierStylePara elsevierViewall">In accordance with the latest guides, in our study severe OSAS was considered to apply when the patients had an apnoea hypopnoea index of <span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>10 per hour, moderate when the apnoea hypopnoea index was between 5–10 and mild when it was between 2-5.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Surgery consisted in adenoidectomy by curettage and tonsillectomy by cold dissection, performing haemostasis with bipolar electrocautery, and a hospital stay for 24<span class="elsevierStyleHsp" style=""></span>h. Most patients stayed in a paediatric ward of the hospital and admission to the PICU was only required in cases where there had been complications in the operating theatre/PARU and in patients with severe comorbidities (polymalformative syndromes, craniofacial malformations) or in children under 3 years of age (due to the number of children in the previous study at this age being small and the fact complication data many not have been conclusive).</p><p id="par0070" class="elsevierStylePara elsevierViewall">Statistical analysis was performed with the R. version 3.1.2, having employed the Kruskal-Wallis test, the Student’s t-test, Chi-square test and the Fisher test according to the types of variables to compare to look for statistical significance, which was established at a <span class="elsevierStyleItalic">P</span> value of <.05. The logistic regression model was also used to assess the influence between different variables and the higher or lower risk of developing complications. The results are expressed in percentages, absolute values, means, standard deviations, odds ratio and 95% confidence intervals. The study had the approval of the ethical committee of the centre where it was conducted.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0075" class="elsevierStylePara elsevierViewall">A total of 622 children were adenotonsillectomised between May 2010 and May 2015, of whom 204 met with the exclusion criteria, with the final sample size comprising 418 children.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The distribution of final sample variables (after ruling out the previous mentioned cases) is reflected in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Out of the 418 patients, distribution by sexes was 56.2% males and 43.8% females, with a global mean age of 5.51 years (3.25), whilst if it is divided by the 2 reasons for surgery, in the OSAS group a slightly lower age was obtained for the recurrent tonsillitis group (4.57 years compared with 6.22 years, respectively). If it is stratified by age groups the sample would be as follows: 9.8% of patients under 3 years, 42.3% of patients between 3 and 5 years and 47.9% de patients over 5 years.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Regarding weight, most patients (75.3%) had a normal weight, with only 9.2% of children in the study being overweight and 15.5% of patients with low weight, mostly in the lower age group.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Regarding the reason for surgery, 56.7%of patients were operated on for tonsillitis, compared to 43.3% who presented with confirmed OSAS. Of this 43.3%, 6.2% had been diagnosed with mild OSAS, 14.6% with moderate OSAS and 22.5% with severe OSAS. This diagnosis was made with respiratory polygraphy or a sleep study in all cases.</p><p id="par0100" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> contains a comparative analysis of complications, whilst <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> focuses on bleeding and respiratory complications, divided over the patient groups.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">Our study maintained that complications are infrequent with a total of 24 children (5.7% of the total sample) presenting with them.</p><p id="par0110" class="elsevierStylePara elsevierViewall">The breakdown of complications was as follows: 5 children (1.2% of the total patients) presented with minor complications (vomiting) compared with 4.3% (19 patients) who had some type of major complication (bleeding or respirator event). Of these the most frequent was postsurgical bleeding which presented in 13 children (3.1% of the total sample), followed in second place by respiratory events in 6 children (1.4% of the total) with broncho-laryngeal spasm (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Stratified by reasons for surgery, 66.7% of complications occurred in patients operated on for recurrent tonsillitis (mostly postsurgical bleeding) and the others (33.3%) in the OSAS patient group.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Probing further into the OSS group it is of note that no complications were observed in any of the mild OSAS but they were in 4.9% of the moderate group (2 patients with bleeding in PARU and one broncho spasm also in the PARU) and 5.3% in the severe group (4 patients with broncho-laryngeal spasm in the PARU and one patient with deferred bleeding at home. Overall, the OSAS were complicated in 3.4% of cases, presenting with a higher number of adverse respiratory events, but always in the operating theatre itself or in the PARU and never in the hospital ward.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Furthermore, children who were operated on for recurrent tonsillitis presented with a higher rate of complications (6.8%), though of lower severity, than those of the other group. In these children operated on for recurrent tonsillitis, the main adverse event was bleeding (68.8% of total complications), which in 72.7% of cases occurred in the hospital ward, whilst in the remaining 27.7% a deferred form of bleeding took place at home. These were mainly mild, prolonging hospitalization or readmission under observation between 24−48<span class="elsevierStyleHsp" style=""></span>h, with only one patient requiring a further operation to control bleeding, with favourable evolution.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Logistic regression models were also created to assess the relationship between the different variables (sex, age, BMI and recurrent tonsillitis) with the presence of global complications and isolated complications of respiration and bleeding. The models are summarized in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>, together with their odds ratio, 95% confidence intervals, and <span class="elsevierStyleItalic">P</span> values, with no statistical significance being found in any of the models.</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0135" class="elsevierStylePara elsevierViewall">There is still unanimous consensus today that first line treatment for children with moderate/severe or even mild OSAS, but with associated comorbidities, is adenotonsillectomy.</p><p id="par0140" class="elsevierStylePara elsevierViewall">The aim of surgery is not only to resolve night time symptoms but also to reverse any associated complications in these patients.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,9</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">It is a safe technique, endorsed by decades of experience, which does not usually present complications in the great majority of patients. When they appear they are essentially minor complications such as poorly controlled pain or vomiting, as occurs in our series.</p><p id="par0150" class="elsevierStylePara elsevierViewall">The vomiting which appeared in our patients was temporary, and at the very most induced administration of intravenous antiemetic medicine and a prolongation of hospital stay by a few hours. There were no cases of dehydration or any other type of major complication due to temporary oral postoperative intolerance. In this respect it appears that good hydration prior to surgery may produce better posterior oral tolerance, together with appropriate pain control.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">One recent meta-analysis<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> concluded that the most common major complications after adenotonsillectomy are respiratory events (9.4%), followed by postoperative bleeding (2.6%). This would vary depending on the reason for surgery and on patients operated on for OSAS there is a 5 times higher risk of presenting with respiratory complications than in those operated on for tonsillitis (odds ratio 4.90%, 95% CI: 2.38–10.10). Also, this same source reports that the OSAS group has a lower risk of bleeding after surgery than those operated on for recurrent adenotonsillitis (odds ratio .41%, 95% CI: .23–.74), maybe due to the fact that the latter patients present with a higher level of inflammation in adenotonsillitis tissues, which could become more fragile, and therefore more susceptible to further bleeding. Other studies<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> also state that the risk of bleeding is higher in obese and older children (between 9 and 18 years) with an odds ratio of 2.3 (95% CI: 1.1–5.1).</p><p id="par0160" class="elsevierStylePara elsevierViewall">In our study a higher number of complications of bleeding was effectively noted in patients who had been operated on for recurrent tonsillitis compared with the OSAS group (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.046), possibly due to the recurrent inflammation of the tonsillar bed. However, there were few obese patients in our study, not enough to research whether or not there was a higher risk of bleeding. We therefore believe further studies in this respect, with larger samples are required.</p><p id="par0165" class="elsevierStylePara elsevierViewall">Furthermore, in our series we also observed a higher number of respiratory complications in the diagnosed cases of severe OSA, which in our studies also occurred in the PARU, with the pertinent measures of support and treatment taking place there, and with favourable evolution in all cases: 6 patients in total (1.4% of the sample), 4 of them with severe OSAS. These data lend support to our hypothesis that the other patients, even though they were diagnosed with severe OSAS, may have spent their postoperative time in a paediatric hospital ward (provided they were over 3 years old and had no serious associated neurological comorbidities, orofacial malformations or the previously mentioned immediate respiratory complications). In the subgroup under 3 years of age we found there was no higher rate of complications (the difference in complications by age was not statistically significant, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.174), but the sample size of the subgroup is not sufficiently large enough to carry out a conclusive analysis and therefore we do not consider the conclusions obtained to be extrapolateable.</p><p id="par0170" class="elsevierStylePara elsevierViewall">We believe it is appropriate for the children with severe OSAS to be operated on in a centre that has a PICU, in case postoperative respiratory complications immediately occur, to ensure they are monitored and early treatment is administered.</p><p id="par0175" class="elsevierStylePara elsevierViewall">Due to the favourable overall evolution of the majority of these patients, it is striking that some centres are putting into practice a very early discharge system for children operated on for mild or moderate OSAS and without any other associated illnesses. As a result the children remain in observation for 6<span class="elsevierStyleHsp" style=""></span>h after surgery and if there are no incidences they are discharged,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> with satisfactory results to date. Further information and research is needed in this respect, which could constitute another line of investigation for future studies.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Limitations</span><p id="par0180" class="elsevierStylePara elsevierViewall">The main limitation of this study is the fact it is retrospective, resulting in some patient data being impossible to recover for analysis (5 patients where the height was not recorded had to be excluded from the anthropometric analysis). Furthermore, poor pain control was not able to be recorded as a minor complication because it was not routinely registered in the clinical files and neither was ethnicity. Regarding the complications, we were unable to record exactly how many hours or days the mean hospital stay was prolonged for in patients who suffered from them, and analysis of this parameter was therefore not possible.</p><p id="par0185" class="elsevierStylePara elsevierViewall">We believe it is necessary to eliminate from the study those patients operated on for suspected OSAS, but without diagnostic tests, because we lack the objective methods to classify them in some of the severity groups studied.</p><p id="par0190" class="elsevierStylePara elsevierViewall">The group of patients under 3 years was smaller in size than the other 2 groups (41 patients), and this resulted in the fact that the results obtained in this age range had to be confirmed with larger simple sized studies prior to extrapolating them to the general population.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusions</span><p id="par0195" class="elsevierStylePara elsevierViewall">In our study, the OSAS has an overall frequency of complications similar to the patients operated on for recurrent tonsillitis, although it is true that severe OSAS presents with more respiratory complications, but in our series they always occurred immediately after the operation (in the operating theatre or the PARU),and therefore, except in these cases or where patients had the previously mentioned risk factors (under 3 years of age, severe neuromuscular disease or major orofacial malformations), routine admission to the ICU was not necessary.</p><p id="par0200" class="elsevierStylePara elsevierViewall">There is a tendency towards greater bleeding in recurrent tonsillitis compared with OSAS, which is significant in this study (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.046), as reflected in other consulted sources.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of Interests</span><p id="par0205" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres1308878" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1208378" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1308879" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1208377" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction and Objectives" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Limitations" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusions" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of Interests" ] 11 => array:2 [ "identificador" => "xack450944" "titulo" => "Acknowledgements" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-08-22" "fechaAceptado" => "2019-01-07" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1208378" "palabras" => array:5 [ 0 => "Tonsillectomy" 1 => "Obstructive sleep apnoea syndrome" 2 => "Adverse events" 3 => "Children" 4 => "Tonsillitis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1208377" "palabras" => array:5 [ 0 => "Adenoamigdalectomía" 1 => "Síndrome de apnea-hipopnea del sueño" 2 => "Complicaciones" 3 => "Niños" 4 => "Amidgalitis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction and objectives</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Adenotonsillectomy is a surgery to treat recurrent tonsillitis or obstructive sleep apnoea syndrome (OSAS). It is considered a safe procedure, with few complications. Moreover, patients over 3 years and without comorbidities do not present a higher rate of respiratory adverse events after the immediate postoperative period, and do not need systematic admission to a paediatric intensive care unit (PICU), regardless of their OSAS severity. The aim of this study is to reanalyse the situation, including patients under the age of 3 years, for whom there are fewer available data, to confirm that this trend has not changed.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">A retrospective observational study was performed, including all adenotonsillectomised children in our hospital over 5 years.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">418 adenotonsillectomised children were included, 56.7% due to recurrent tonsillitis, and 43.3% because of OSAS. Only 24 patients (5.7%) experienced adverse events, of whom 1.2% had vomiting, 3.1% bleeding, and 1.4% respiratory events. All the respiratory events occurred in the operating theatre or in the post-anaesthetic unit, most frequently in children with severe OSAS, while the tonsillitis group had more bleeding (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.046). No differences in complications were observed according to age (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.174), but the group of patients under three years was relatively small.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">No differences were found in the percentage of complications between the two groups. Although the OSAS group exhibited more respiratory events, these occurred in the immediate postoperative period; otherwise, there was a higher risk of bleeding in the tonsillitis group. These results support the findings indicating that routine PICU admission is not required for these patients.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction and objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción y objetivos</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">La adenoamigdalectomía es una cirugía indicada por amigdalitis recurrentes e igualmente por síndrome de apnea-hipopnea del sueño (SAHS). Es considerada segura y con pocas complicaciones. Así, en pacientes mayores de 3 años y sin comorbilidades, no hay más complicaciones respiratorias (fuera del postoperatorio inmediato), por lo que no precisan la hospitalización rutinaria en unidad de cuidados intensivos pediátricos (UCIP), independientemente de la gravedad del SAHS. El objetivo de este estudio es reanalizar la situación, para comprobar que esta tendencia se mantiene, poniendo especial énfasis en menores de 3 años, subgrupo donde hay menos datos disponibles.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Métodos</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo observacional, incluyendo los niños adenoamigdalectomizados en nuestro centro durante 5 años.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Se operaron 418 niños (56,7% por amigdalitis y 43,3% por SAHS). Sólo 24 (5.7%) tuvieron complicaciones: un 1.2% vómitos, un 3,1% sangrados y un 1.4%, respiratorias. Estas últimas ocurrieron siempre en quirófano o recuperación post-anestésica y más frecuentemente en SAHS grave, mientras que las amigdalitis tuvieron más sangrados (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,046). No hay diferencias por edad (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,174) aunque el subgrupo de menores de 3 años sigue siendo más pequeño.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">No encontramos diferencias en el porcentaje de complicaciones entre SAHS y amigdalitis. Las amigdalitis tienen más sangrados; y el SAHS grave más complicaciones respiratorias, pero siempre en el postoperatorio inmediato en nuestra serie. Estos datos apoyan la hipótesis previa de no ingresar rutinariamente en UCIP salvo en los casos anteriormente mencionados.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción y objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: Rodríguez-Catalán J, Fernández-Cantalejo Padial J, Rodríguez Rodríguez P, González Galán F, del-Río Camacho G. Complicaciones postoperatorias tras adenoamigdalectomía en 2 grupos de pacientes pediátricos: síndrome de apnea-hipopnea del sueño e infecciones de repetición. Acta Otorrinolaringol Esp. 2020;71:32–39.</p>" ] ] "multimedia" => array:6 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 946 "Ancho" => 1419 "Tamanyo" => 70978 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Complications in the whole sample (absolute values) Gr.1.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">BMI: body mass index; OSAS: obstructive sleep apnoea syndrome ; SDS: standard deviations.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Sex</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Males: 235 (56.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Females: 183 (43.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Mean global age</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>5.5 years (±3.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Mean age by surgical groups</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Recurrent tonsillitis 6.22 years (±3.63) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>OSAS: 4.57 years (±2.38) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Age intervals</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>3 years: 41 children (9.8%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>2-5 years: 177 children (42.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>5 years: 200 children (47.9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Nutritional status (BMI)</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Low weight (BMI<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>–2<span class="elsevierStyleHsp" style=""></span>SDS): 64 children (15.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Normal weight (BMI entre –2 y<span class="elsevierStyleHsp" style=""></span>+2 SDS): 311 children (75.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Overweight (BMI<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>+2 SDS): 38 children (9.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Reason for surgery</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mild OSAS: 26 children (6.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Moderate OSAS: 61 children (14.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Severe OSAS: 94 children (22.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Recurrent tonsillitis: 237 children (56.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2242941.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Over a total of 413 children (5 lost for subanalysis because their height data were not available).</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Descriptive Data of the Final Sample (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>418).</p>" ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">BMI: body mass index; OSAS: obstructive sleep apnoea syndrome ; PARU: post-anaesthesia recovery unit.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Severity and type of complications</span>• Minor: 5 children (1.2% of the total patients 20.8% of total complications): 5 children with vomiting• Major: 19 children (4.3% of the total patients, 79.2% of total complications): 13 children with bleeding and 6 children with broncho-laryngeal spasms<span class="elsevierStyleItalic">Time of complication (% over total complications)</span>• Operating theatre/PARU: 14 complications (58.3% of total complications)• Ward: 7 complications (29.2%)• Home: 3 complications (12.5%)<span class="elsevierStyleItalic">By age (years):</span>• Mean age in the group with complications: 5.5<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.3• Mean age in the group without complications : 5.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>2.9<span class="elsevierStyleItalic">By each age group:</span>• <<span class="elsevierStyleHsp" style=""></span>3 years (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>41): 5 complications (12%)• 3–5 years (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>177): 9 complications (5%)• ><span class="elsevierStyleHsp" style=""></span>5 years (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>200): 10 complications (5%)<span class="elsevierStyleItalic">By weight (BMI-Z score)</span>• BMI of the group with complications: 16.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>7.2• BMI of the group without complications: 16.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.3<span class="elsevierStyleItalic">By classification according to weight</span>• Low weight (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>64): one complication (1.6%)• Normal weight (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>311): 19 with complications (6.1%)• Obesity (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>38): 2 with complications (5.3%)• Lost: 5 patients where the height was not available, so no BMI could be calculated<span class="elsevierStyleItalic">Complications by reason for surgery:</span>• OSAS (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>181): 8 children with complications (4.4% complications)• Mild OSAS (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>26): no complication (0%)• Moderate OSAS (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>61): 3 complications (4.9%)• Severe OSAS (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>94): 5 complications (5.3%)• Recurrent Tonsillitis (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>237): 16 children with complications (6.8% of complications)<span class="elsevierStyleItalic">Percentage of severe OSAS complications: 5.3% compared with the rest (mild, moderate OSAS and recurrent tonsillitis): 5.9%</span><span class="elsevierStyleItalic">Percentage of OSAS complications of any severity (4.4%) compared with recurrent tonsillitis (6.8%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.598<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.174<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.996<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.337<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.704<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.422 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2242939.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Description and Analysis of Complications (24 Complications in 418 Children [5.7% of the Total Patients]).</p>" ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">OSAS: obstructive sleep apnoea syndrome.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Respiratory complications</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.062 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">In whole sample (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>418): 6 respiratory complications (1.4%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">In the severe OSAS group (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>94): 4 respiratory complications (4.3%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">In the mild/moderate OSAS groups (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>87):one respiratory complication (1.6%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">In the recurrent tonsillitis group (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>237): one respiratory complication (.4%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Bleeding complications</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Due to reason for surgery</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.046 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">OSAS of any severity (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>181): 2 cases of bleeding (1.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Recurrent tonsillitis (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>237): 11 cases of bleeding (4.6%). \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2242940.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Analysis of Bleeding and Respiratory Complications.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Left side:</span> these 3 tables (global, respiratory and bleeding complications) take as explanatory variables sex, age, body mass index (BMI) and the presence of recurrent tonsillitis or OSAS. In the case of sex reference category is males and in the case of reason for surgery recurrent tonsillitis.</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Right side:</span> these 2 tables have a similar model to the first 3, but they compare patients with severe OSAS with the other groups (mild, moderate OSAS and recurrent tonsillitis). No bleeding complication table is included because it was impossible to calculate this model with the severe OSAS variable since none of the patients with severe OSAS presented with bleeding.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><elsevierMultimedia ident="202002150657415861"></elsevierMultimedia> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2242938.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Logistic Regression Models for Complications.</p>" ] ] 5 => array:5 [ "identificador" => "202002150657415861" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 667 "Ancho" => 844 "Tamanyo" => 92479 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Complicaciones postoperatorias tras adenoamigdalectomía en niños con síndrome de apnea-hipopnea del sueño severo. ¿Requieren ingreso en unidad de cuidados intensivos?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "G. Del-Río Camacho" 1 => "M. Martínez González" 2 => "J. Sanabria Bossart" 3 => "E. Gutiérrez Moreno" 4 => "T. Gómez García" 5 => "F. Troncoso Acevedo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.otorri.2014.03.004" "Revista" => array:7 [ "tituloSerie" => "Acta Otorrinolaringol Esp." "fecha" => "2014" "volumen" => "65" "numero" => "5" "paginaInicial" => "302" "paginaFinal" => "307" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24882467" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Routine post-operative intensive care is not necessary for children with obstructive sleep apnea at high risk after adenotonsillectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Theilhaber" 1 => "S. Arachchi" 2 => "D.S. Armstrong" 3 => "M.J. Davey" 4 => "G.M. Nixon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijporl.2014.01.032" "Revista" => array:7 [ "tituloSerie" => "Int J Pediatr Otorhinolaryngol." "fecha" => "2014" "volumen" => "78" "numero" => "5" "paginaInicial" => "744" "paginaFinal" => "747" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24594232" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adenotonsillectomy Complications: A Meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. De Luca Canto" 1 => "C. Pachêco-Pereira" 2 => "S. Aydinoz" 3 => "R. Bhattacharjee" 4 => "H.L. Tan" 5 => "L. Kheirandish-Gozal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1542/peds.2015-1283" "Revista" => array:7 [ "tituloSerie" => "Pediatrics." "fecha" => "2015" "volumen" => "136" "numero" => "4" "paginaInicial" => "702" "paginaFinal" => "718" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26391937" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Routine post-operative intense care is not necessary for children with obstructive sleep apnea at high risk after adenotonsillectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Theilhaber" 1 => "S. Arachchi" 2 => "D.S. Armstrong" 3 => "M.J. Davey" 4 => "G.M. Nixon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijporl.2014.01.032" "Revista" => array:6 [ "tituloSerie" => "International Journal of Pediatric Otorhinolaryngology." "fecha" => "2014" "volumen" => "78" "paginaInicial" => "744" "paginaFinal" => "747" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24594232" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Respiratory complications after diode-laser-assisted tonsillotomy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Fischer" 1 => "I. Horn" 2 => "M. Quante" 3 => "A. Merkenschlager" 4 => "J. Schnoor" 5 => "U.X. Kaisers" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00405-014-2956-z" "Revista" => array:6 [ "tituloSerie" => "Eur Arch Otorhinolaryngol." "fecha" => "2014" "volumen" => "271" "paginaInicial" => "2317" "paginaFinal" => "2324" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24615650" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Is day stay adenotonsillectomy safe in children with mild to moderate obstructive sleep apnoea? A retrospective review of 100 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "K. Baguley" 1 => "A.T. Cheng" 2 => "C. Castro" 3 => "N. Wainbergas" 4 => "K.A. Waters" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijporl.2013.10.050" "Revista" => array:6 [ "tituloSerie" => "Int J Pediatr Otorhinolaryngol." "fecha" => "2014" "volumen" => "78" "paginaInicial" => "71" "paginaFinal" => "74" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24287254" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Quantifying respiratory complications post-adenotonsillectomy in patients with normal or inconclusive overnight oximetry" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T.N.T. Lee" 1 => "C.E. Lefebvre" 2 => "N.E. Gans" 3 => "S.J. Daniel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "J Otolaryngol Head Neck Surg." "fecha" => "2013" "volumen" => "42" "paginaInicial" => "50" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Is fasting duration important in post adenotonsillectomy feeding time?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Y. Jabbari Moghaddam" 1 => "M. Seyedhejazi" 2 => "M. NaderPour" 3 => "Y. Yaghooblua" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Anesth Pain Med" "fecha" => "2014" "volumen" => "4" "numero" => "1" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of adenotonsillectomy on nocturnal enuresis in children with sleep-disordered breathing: a prospective study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Park" 1 => "J.M. Lee" 2 => "C.S. Sim" 3 => "J.G. Kim" 4 => "J.G. Nam" 5 => "T.H. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/lary.25934" "Revista" => array:7 [ "tituloSerie" => "Laryngoscope" "fecha" => "2016" "volumen" => "126" "numero" => "5" "paginaInicial" => "1241" "paginaFinal" => "1245" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26928519" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increased immediate postoperative hemorrhage in older and obese children after outpatient tonsillectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R. Kshirsagar" 1 => "H. Mahboubi" 2 => "D. Moriyama" 3 => "O. Ajose-Popoola" 4 => "N.S. Pham" 5 => "G.S. Ahuja" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ijporl.2016.02.019" "Revista" => array:6 [ "tituloSerie" => "Int J Pediatr Otorhinolaryngol." "fecha" => "2016" "volumen" => "84" "paginaInicial" => "119" "paginaFinal" => "123" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27063766" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis and treatment of sleep-apnea hypopnea sundrome. Spanish Society of Pulmonology and Thoraci Surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Lloberes" 1 => "J. Durán-Cantollá" 2 => "M.A. Martínez-García" 3 => "J.M. Marín" 4 => "A. Ferrer" 5 => "J. Corral" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Arch Bronconeumol." "fecha" => "2011" "volumen" => "47" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Documento de consenso del síndrome de apneas-hipopneas durante el sueño en niños" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:1 [ 0 => "M.L. Alonso-Álvarez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0300-2896(11)70028-X" "Revista" => array:7 [ "tituloSerie" => "Arch Bronconeumol." "fecha" => "2011" "volumen" => "47" "numero" => "Supl 5" "paginaInicial" => "2" "paginaFinal" => "18" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21703472" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack450944" "titulo" => "Acknowledgements" "texto" => "<p id="par0210" class="elsevierStylePara elsevierViewall">The authors would like to express their thanks to Mr. Ignacio Mahillo for his help with the statistical data analysis.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735735/0000007100000001/v1_202002150657/S2173573520300016/v1_202002150657/en/main.assets" "Apartado" => array:4 [ "identificador" => "5871" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735735/0000007100000001/v1_202002150657/S2173573520300016/v1_202002150657/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173573520300016?idApp=UINPBA00004N" ]
