Severe obesity in children as an independent risk factor for perioperative respiratory adverse events during anaesthesia for minor non-airway surgery, a retrospective observational study

Abstract

The purpose of this article is to quantify grades of obesity and their independent effects on perioperative adverse events in children having ambulatory minor non-airway surgery. Methods: After obtaining ethics committee approval, we selected every tenth child aged 2 to 16 years who was identified as having been a day case between January 2012 and December 2014. Weight groups were defined based on age-and genderspecific body mass index (BMI) cutoff points. A sample size of 1102 was calculated to demonstrate a threefold increase in the primary outcome measure, perioperative respiratory-airway adverse events, among obese children, with a power of 80% and an alpha error of 5%. Chi-squared and Fisher exact tests were used to compare proportions, and independent sample t tests were used to compare means. Results: Severely obese children had a significantly higher incidence of perioperative respiratory-airway adverse events when compared to normal-weight children despite no difference in respiratory and other comorbidity. Obese children had higher prevalence of overall medical comorbidities and obstructive sleep apnoea when compared to normal-weight children and there was no significant difference in the incidence of perioperative respiratory-airway adverse events and other outcome measures between obese and normal-weight children. Conclusions and recommendations: Severely obese children have a higher risk of perioperative respiratory-airway adverse events even during minor non-airway surgery despite absence of medical comorbidities. We recommend the use of age-and sex-specific BMI cutoffs or BMI percentile charts to identify children who are severely obese to anticipate and prevent major respiratory adverse events.

Pediatric airway: What is new in approaches and treatments?

“…In children who cooperate, the inability to project the mandible farther than the maxilla (inability to bite the upper lip with the lower teeth) is a finding associated with DA. A higher body mass index (obesity) is associated with greater perioperative complications (8).…”

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

“…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.…”