Perioperative outcomes of severely obese children undergoing tonsillectomy

Abstract

Background Sleep-disordered breathing, a common condition in obese children, is a frequent indication for tonsillectomy. Objective The purpose of this study was to examine the association between obesity and perioperative complications in children undergoing tonsillectomy. Methods/Materials A sample of 100 severely obese children (body mass index for age, BMIA, ≥98th percentile) between ages 2 to 18 years who underwent tonsillectomy at Mayo Clinic Rochester was randomly selected. Each severely obese child was age (±2 years) and sex matched to two normal weight children (body mass index for age between 25th-75th percentiles) undergoing tonsillectomy in the same calendar year, and their medical records were reviewed. Results Severely obese children had a significantly higher incidence of comorbid conditions including respiratory disorders and severe systemic disorders or syndromes. Severely obese children had a higher frequency of perioperative airway complications (15.0% vs. 2.0%). From post-hoc analyses, severe obesity remained a significant risk factor for perioperative adverse events after adjusting for the presence of severe systemic disorders or syndromes (OR 8.8; 95% CI 2.8-27.5, P<0.001) and also after adjusting for preoperative respiratory disorders (OR 7.7; 95% CI 2.5-24.3, P<0.001). When children with planned admissions were excluded from the analysis, severe obesity was associated with an increased rate of unplanned hospital admission (OR 3.80, 95% CI 1.83-7.87, P<0.001). Conclusions Severe obesity in children undergoing tonsillectomy is independently associated with an increased risk of perioperative complications. It appears that both severe obesity and systemic comorbid condition contribute to higher proportions of inpatient tonsillectomies performed in our institution.

Pre‐operative parameters do not reliably identify post‐operative respiratory risk in children undergoing adenotonsillectomy

“…17,22 Obesity has been shown to be a significant risk factor for postoperative complications in children post-AT. [23][24][25][26] Interestingly, we did not find a similar association in our study. 27 One possible explanation for this is most of our study children had a BMI less than 30 kg/m 2 plus they did not have any other comorbidities.…”

“…Obesity has been shown to be a significant risk factor for post‐operative complications in children post‐AT . Interestingly, we did not find a similar association in our study .…”

No association between obesity and post-tonsillectomy haemorrhage

“…14 In a matched case-control study of tonsillectomy patients, severely obese children with or without OSA had a higher risk for peri-operative complications than normal weight controls. 15 The authors considered that both severe obesity itself and systemic co-morbid conditions in obese children contributed to the observed higher complication rate. Overall, the literature consistently indicates an increased risk for respiratory problems following tonsillectomy, at least in overweight children.…”

Do Obese Children Require Inpatient Monitoring After Adenotonsillectomy?

“…1 There are several reports showing increased respiratory complications during perioperative and postoperative periods following AT in obese children, although these reports are retrospective and observational studies. [5][6][7][8] Two prospective studies evaluating polysomnographic findings immediately after AT yielded conflicting results. 9,10 Both studies failed to specifically assess obese children.…”

“…One previous study suggested that obesity was a risk factor for postoperative respiratory complications following AT independent of sleep-disordered breathing, but the subjects in that study were severely obese children. 8 How long do we need to monitor these children? Prior studies have shown that apnea and desaturation may not be apparent until 5 to 18 hours postoperatively, partly due to alteration in timing of rapid eye movement sleep.…”