Adenotonsillectomy in the morbidly obese child
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Published on: November 6, 2019
Andrew Spector1, Sara Scheid, Sandra Hassink
1Department of Otolaryngology, Thomas Jefferson University Hospital, 111 S. 11th Street, Philadelphia, PA 19134, USA.
Insights
Routine pediatric intensive care unit admission is not necessary for most morbidly obese children after adenotonsillectomy. While some required interventions, these can be managed on a surgical floor, suggesting the procedure is not as risky as believed.
Area of Science:
- Pediatric Surgery
- Obesity Medicine
- Anesthesiology
Background:
- Pediatric obesity prevalence has significantly increased, leading to more surgical procedures in this population.
- Adenotonsillectomy (AT) is a common pediatric surgical procedure.
- The safety and complication rates of AT in morbidly obese (MO) children require further investigation.
Purpose of the Study:
- To determine the complication rate in MO children undergoing AT.
- To assess the necessity of elective pediatric intensive care unit (PICU) admission for observation in MO children post-AT.
Main Methods:
- Retrospective study of postoperative PICU admissions over 4 years.
- Analysis of 14 MO children (BMI >95th percentile) who underwent AT for obstructive sleep apnea.
- Outcomes were determined based on postoperative complications and interventions.
Main Results:
- Two patients required bi-level positive airway pressure (BiPAP) for desaturation.
- One patient required prolonged intubation (10 days).
- Three patients needed supplemental oxygen; interventions were manageable on a surgical floor.
Conclusions:
- Routine PICU admission is not warranted for most MO children undergoing AT.
- Interventions required by some MO patients can be managed in a surgical floor bed.
- Further prospective studies using preoperative polysomnograms are recommended to identify indicators for PICU admission.
Objective:
The prevalence of obesity in the pediatric population has risen more than 20% in 25 years. Accordingly, surgical procedures on obese children have become more common. Adenotonsillectomy (AT) remains among the most frequently performed pediatric surgical procedures in the United States. Our objective was to determine if there is an increased complication rate in morbidly obese (MO) children undergoing AT and if elective pediatric intensive care unit (PICU) admission for observation is warranted.
Methods:
This retrospective study includes postoperative admissions to the PICU over a 4-year period at one hospital. Out of 957 adenotonsillectomies performed by one surgeon, 543 were admitted to the hospital. Fourteen MO children were identified. Using body mass index (BMI; weight in kg/m(2)), as calculated for age appropriate categories, postoperative outcomes of AT in MO children (>95th percentile BMI) were determined. These 14 were electively admitted to the PICU for airway observation. The indication for surgery in these 14 children was obstructive sleep apnea. Ages ranged from 4 to 15 years. There were 11 males and 3 females.
Results:
Two patients required overnight bi-level positive airway pressure (BiPAP) for oxygen desaturation. One patient remained intubated for 10 days. Three patients required supplemental oxygen. Four of these admissions had preoperative polysomnograms (PSGs).
Conclusions:
Our study concluded that routine PICU admission was not warranted for most MO patients although several required supplemental oxygen, BiPAP, and one required intubation. These interventions can easily be administered in a surgical floor bed. In fact, these results imply that performing this surgical procedure in obese children is not as risky as many believe. Trends were noted for an increased need of airway interventions in children requiring preoperative BiPAP and in those with comorbidities. In this small population, sample AT was performed on the basis of history. This is to serve as a pilot review for a prospective study in which preoperative PSGs would be used to determine potential indicators for elective PICU admission.
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