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Published on: November 6, 2019
Perioperative outcomes of severely obese children undergoing tonsillectomy
Stephen J Gleich1, Michael D Olson, Juraj Sprung
1Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA.
Insights
Severely obese children undergoing tonsillectomy face higher risks of perioperative complications and unplanned hospital admissions. Severe obesity is an independent risk factor, contributing to increased inpatient procedures.
Area of Science:
- Pediatric Surgery
- Obesity Medicine
- Anesthesiology
Background:
- Sleep-disordered breathing is common in obese children and often necessitates tonsillectomy.
- Tonsillectomy is a frequent surgical procedure for pediatric sleep-disordered breathing.
Purpose of the Study:
- To investigate the association between severe obesity and perioperative complications in children undergoing tonsillectomy.
- To determine if severe obesity is an independent risk factor for adverse events during tonsillectomy.
Main Methods:
- A retrospective review of 100 severely obese children (BMI-for-age ≥ 98th percentile) undergoing tonsillectomy.
- Matched comparison with normal-weight children (BMI-for-age 25th-75th percentile) for age and sex.
Main Results:
- Severely obese children exhibited a higher incidence of comorbidities, including respiratory and systemic disorders.
- Perioperative airway complications were significantly more frequent in severely obese children (15.0% vs. 2.0%).
- Severe obesity independently predicted perioperative adverse events and unplanned hospital admissions.
Conclusions:
- Severe obesity is an independent risk factor for perioperative complications in pediatric tonsillectomy.
- Both severe obesity and comorbid conditions contribute to the higher rate of inpatient tonsillectomies.
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], ≥ 98 th percentile) between ages 2 and 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 (BMIA between 25th and 75th percentiles) undergoing tonsillectomy during the study period, 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 posthoc 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 1.8-7.9, 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.
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