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Analysis of Growth Curves in Children After Adenotonsillectomy
Josephine A Czechowicz1, Kay W Chang1
1Department of Otolaryngology-Head and Neck Surgery, Lucille Packard Children's Hospital, Stanford University School of Medicine, Stanford, California.
Insights
Children younger than 4 years and with lower weight percentiles experience significant weight gain after adenotonsillectomy. This growth shift is not linked to increased obesity rates in these pediatric patients.
Area of Science:
- Pediatric endocrinology
- Growth and development
- Otolaryngology
Background:
- Adenotonsillectomy is a common pediatric procedure.
- Previous studies indicate significant weight gain in children post-adenotonsillectomy.
- Understanding growth patterns after surgery is crucial for pediatric care.
Purpose of the Study:
- To analyze changes in weight and stature percentiles in children following adenotonsillectomy.
- To identify clinical and demographic factors associated with growth curve shifts post-surgery.
- To investigate the relationship between adenotonsillectomy and subsequent weight gain patterns.
Main Methods:
- Retrospective review of medical records for patients aged 18 and younger.
- Inclusion of patients with pre- and post-operative height and weight measurements at specific intervals.
- Logistic regression analysis to correlate patient demographics and preoperative status with percentile changes.
Main Results:
- Significant increases in mean weight (6.3 percentile points) and body mass index (8.0 percentile points) were observed 18 months post-surgery.
- Younger children (under 4 years) and those with lower preoperative weight percentiles (1st-60th) showed the most substantial weight gain.
- Children already above the 80th weight percentile pre-surgery did not exhibit significant weight percentile increases.
Conclusions:
- Post-adenotonsillectomy weight gain is most pronounced in younger, smaller children.
- The observed weight gain does not appear to correlate with an increased risk of obesity in this pediatric cohort.
- Findings highlight the importance of monitoring growth trajectories in specific pediatric subgroups after adenotonsillectomy.
Importance:
Several studies have documented that children gain more weight than expected after adenotonsillectomy.
Objectives:
To examine patterns of change in weight and stature percentiles in children after adenotonsillectomy and to analyze clinical and demographic correlates of shifts in the growth curve.
Design, Setting, And Participants:
In this retrospective medical record review, we studied patients 18 years and younger who underwent adenotonsillectomy at an academic pediatric tertiary medical center and had at least one height and weight measurement recorded at each of the following time points: within 3 months before surgery, within 3 to 9 months after surgery, and within 12 to 27 months after surgery. Data were procured from all children from January 1, 2007, through October 31, 2012, and initially included 2893 surgical patients and 161,458 height and weight measurements. The final database consisted of 815 patients with adequate growth data and multiple time points. Logistic regression analysis was performed to examine patient age at surgery, preoperative weight, sex, and ethnic background for correlations with changes in weight, height, and body mass index percentiles.
Main Outcomes And Measures:
Change in weight, height, and body mass index percentile before and after surgery.
Results:
At 18 months after surgery, weight percentiles in the study group increased by a mean of 6.3 percentile points (P < .001). Body mass index percentiles increased by a mean of 8.0 percentile points (P < .001). The greatest increases in weight percentiles were observed in children who were between the 1st and 60th percentiles for weight (P < .001) and younger than 4 years at the time of surgery (P < .001). An increase in weight percentile was not observed in children who preoperatively were already above the 80th percentile in weight (P = .15).
Conclusions And Relevance:
Weight gain after adenotonsillectomy occurs primarily in patients who are smaller and younger at the time of surgery and does not correlate with increased rates of obesity.
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