Pediatric obesity and perioperative medicine

Mpody, Christian; Owusu-Bediako, Kwaku; Raman, Vidya; Nafiu, Olubukola O.

doi:10.1097/aco.0000000000000991

Cited by 5 publications

(5 citation statements)

References 73 publications

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“…Nonetheless, regardless of the care setting, the observations from these earlier studies are commonly used in making recommendations for the perioperative care of children with obesity. 17 Very few studies have examined the prevalence of obesity in a pediatric ambulatory surgical population, 18 and no pediatric study to date has described obesity trends or the association of obesity with hospital admission following ambulatory surgery. Recent data from adults have yielded conflicting results on the outcome of morbidly obese patients who underwent ambulatory surgery.…”

Section: Discussionmentioning

confidence: 99%

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Childhood obesity trends: Association with same‐day hospital admission in a National Outpatient Surgical Population

Tram

Mpody

Owusu-Bediako

et al. 2022

Pediatric Anesthesia

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Background Although the prevalence of obesity in the general population and its perioperative implications among children undergoing inpatient surgeries are well known, little is known about obesity prevalence among children scheduled for ambulatory surgery. Aims Here, we report the trends of obesity and severe obesity among children who underwent ambulatory surgery across multiple centers in the United States and explore the association of obesity status with admission following elective ambulatory surgery. Materials and Methods Using data from the American College of Surgeons National Surgical Quality Improvement Program‐Pediatric (2012–2019), we selected children 2–18 years old who underwent outpatient surgical procedures under general anesthesia and had documented height, weight, and body mass index (BMI) data. We estimated the prevalence of overweight, obesity (class 1), and severe obesity (class 2 and class 3) patients and explored their association with same‐day hospital admission, defined as hospital length of stay ≥1 day. Results Data from 152 918 children (mean age: 9.7 ± 4.7 years) were analyzed. Of these, 16.4% (n = 25 007) were overweight, 13.8% (n = 21 085) were class 1 obese, 5.2% (n = 7879) were class 2 obese, and 3.0% (n = 4623) were class 3 obese. From 2012 to 2019, class 2 or 3 obesity prevalence increased by 26.7% and 32.5%, respectively. Overweight and obese children had relatively higher odds of same‐day hospital admission compared to healthy weight children (overweight odds ratio [95% confidence interval]: 1.05 [1.02, 1.08]; class 1 obesity: 1.04 [1.00, 1.07]; class 2 obesity: 1.09 [1.02, 1.16]; class 3 obesity: 1.20 [1.11, 1.30]). Discusion and Conclusion The burden of obesity continues to increase in children scheduled for ambulatory surgery. Children with class 2 and class 3 obesity have higher rates of same‐day hospital admission following elective ambulatory surgery compared to healthy weight children, a factor that should be considered in scheduling these patients.

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Section: Discussionmentioning

confidence: 99%

“…These earlier studies have typically treated children with obesity as a homogenous group. Nonetheless, regardless of the care setting, the observations from these earlier studies are commonly used in making recommendations for the perioperative care of children with obesity 17 …”

Section: Discussionmentioning

confidence: 99%

Childhood obesity trends: Association with same‐day hospital admission in a National Outpatient Surgical Population

Tram

Mpody

Owusu-Bediako

et al. 2022

Pediatric Anesthesia

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“…Obesity increases perioperative respiratory adverse events [7 ▪ ,19] as well as the likelihood of unanticipated admission [7 ▪ ,22 ▪▪ ]. A recent study of the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database by Tram et al [22 ▪▪ ] found higher rates of same day hospital admission following elective ambulatory surgery in children with severe (Class 2/3) obesity compared to healthy weight children.…”

Section: Obesitymentioning

confidence: 99%

“…They may also fail to appreciate the increased perioperative risks certain pediatric comorbidities lend. This can lead to a false sense of security and lack of preparedness, which may result in failure to rescue [7 ▪ ]. The ability to intervene early to avert a crisis is influenced by both institutional and provider experience and preparedness [8].…”

Section: Introductionmentioning

confidence: 99%

The high-risk pediatric patient for ambulatory surgery

Webber,

Brennan

2023

Current Opinion in Anaesthesiology

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Purpose of review The aim of this article is to briefly review the pediatric ambulatory surgery landscape, identify two of the most common comorbidities affecting this population, examine the influence of pediatric obesity and sleep disordered breathing (SDB)/obstructive sleep apnea (OSA) on perioperative care, and provide information that can be used when formulating site specific criteria for ambulatory surgical centers. Recent findings Most pediatric surgeries performed are now ambulatory, a majority of which take place outside of academic centers. Children with comorbidities such as obesity and SDB/OSA are undergoing surgical or diagnostic procedures which were previously deemed unacceptable for ambulatory surgery. The increase in pediatric ambulatory surgery coupled with a recent shortage of pediatric anesthesiologists means many children will receive anesthesia care from general clinicians who care for children intermittently and may be unfamiliar with the perioperative risks these comorbidities can present. Summary Our pediatric ambulatory surgical population is anticipated to demonstrate increasing rates of obesity and SDB/OSA. Bringing attention to potential perioperative complications associated with these comorbidities provides a stronger foundation upon which to formulate criteria for individual ambulatory centers. It allows for targeted anesthetic management, influences provider assignments and/or staffing ratios, and informs scheduling times. For anesthesiologists who do not practice pediatric anesthesia daily, knowing what to anticipate plays a significant role in the ability to eliminate surprises and care for these patients safely.

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“…A number of studies in the anesthesia literature suggest that children with obesity are more likely to experience intraoperative adverse events, including airway obstruction and oxygen desaturations, than their healthyweighted peers. [8][9][10][11][12][13][14][15] It remains unclear whether these observations extend to all surgical interventions, or whether there are specific BMI limits above which standard pediatric anesthesia protocols should be adapted. In contrast, there are several recent studies that suggest the majority of children with obesity complete surgical treatment without experiencing adverse events.…”

Section: Introductionmentioning

confidence: 99%

Body Mass Index (BMI) Impact on Anesthetic Safety among Adolescents Undergoing Bilateral Reduction Mammaplasty

Cappitelli

McNamara

Nuzzi

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Introduction: Obesity is common in adolescents with macromastia seeking surgery, prompting concerns over anesthesia-related complications due to obesity. This may lead to weight-based surgical policies, despite limited research. This study’s purpose is to examine the impact of obesity status on perioperative anesthetic-related adverse events/surgical complications in adolescents/young adults undergoing bilateral reduction mammaplasty. Methods: A medical record query was performed to retrospectively identify patients who underwent bilateral reduction mammaplasty at our institution between January 2021 and December 2021. Patient demographics and clinical/surgical data were obtained from medical records. Pearson’s chi-square, Fisher exact, and Median tests were used to examine associations between body mass index (BMI) category and clinical/demographic data. Results: Two hundred patients were included in analyses, with a median age at surgery of 18.0 years. The majority of patients were obese (63.5%, n = 127), and none were underweight. The most common comorbidity was asthma (27.0%, n = 54). There were no anesthetic-related intraoperative complications or delayed waking. The following did not significantly differ by BMI category: proportion of patients who experienced oxygen desaturation (pre-, intra-, or postoperatively), frequency of postoperative complications, and length of postanesthesia care unit and total hospital stays (P > 0.05, all). Conclusions: While institutions may implement weight-based surgical policies due to anesthesia-related complication concerns in patients with obesity, our study showed that BMI category did not significantly impact anesthetic-related adverse events/surgical complications in our sample. This suggests that such policies are not warranted in all situations, and that decisions regarding their necessity be data-driven.

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Pediatric obesity and perioperative medicine

Cited by 5 publications

References 73 publications

Childhood obesity trends: Association with same‐day hospital admission in a National Outpatient Surgical Population

Childhood obesity trends: Association with same‐day hospital admission in a National Outpatient Surgical Population

The high-risk pediatric patient for ambulatory surgery

Body Mass Index (BMI) Impact on Anesthetic Safety among Adolescents Undergoing Bilateral Reduction Mammaplasty

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