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Early Adverse Respiratory Outcomes in Obese Pediatric Tonsillectomy Patients
Kathryn Wie1, Nicholas Zaccor1, Jonathan Zou2
1Department of Otolaryngology, University of Rochester, Rochester, New York, USA.
Insights
Obese children undergoing tonsillectomy rarely experience adverse respiratory events (AREs). Preoperative polysomnogram (PSG) findings like obstructive apnea-hypopnea index (oAHI) and oxygen saturation (SpO2) better predict AREs than body mass index (BMI).
Area of Science:
- Pediatric Otolaryngology
- Pediatric Anesthesiology
- Sleep Medicine
Background:
- Obesity is a growing concern in pediatric populations.
- Tonsillectomy is a common surgical procedure in children.
- Adverse respiratory events (AREs) are a potential risk following tonsillectomy, particularly in obese children.
Purpose of the Study:
- To investigate the predictive value of Body Mass Index (BMI) for perioperative Adverse Respiratory Events (AREs) in obese children undergoing tonsillectomy.
- To identify other potential predictors of AREs in this patient population.
Main Methods:
- A case series with chart review was conducted at a single academic otolaryngology practice.
- Included were 3-12 year old patients with BMI ≥95th percentile undergoing tonsillectomy between March 2011 and July 2020.
- Patients with comorbidities requiring independent admission were excluded. AREs were defined as postoperative desaturation (SpO2 <90%), intubation, CPAP, or >2 hours of supplemental oxygen.
Main Results:
- Eighteen patients (8%) experienced at least one ARE.
- No children aged 5 and older with a BMI between the 95th and 98.9th percentile had early AREs.
- Preoperative polysomnogram (PSG) metrics, including obstructive apnea-hypopnea index (oAHI) and oxygen saturation (SpO2) nadir, were significantly different between patients with and without AREs (P=.02 and P=.05, respectively). BMI z-score did not significantly differ between groups (P=.09).
Conclusions:
- Adverse respiratory events requiring inpatient management are infrequent in obese children post-tonsillectomy.
- Body Mass Index (BMI) is a poor predictor of AREs, except at extreme values.
- Higher oAHI and lower SpO2 nadir on PSG are significant indicators of ARE risk, guiding postoperative admission decisions. Some obese pediatric tonsillectomy patients may be candidates for same-day discharge.
Objective:
To determine if body mass index (BMI) is predictive of adverse respiratory events (ARE) in the obese pediatric population undergoing tonsillectomy.
Study Design:
Case series with chart review.
Setting:
Single institution academic otolaryngology practice.
Methods:
All patients 3 to 12 years old with BMI ≥95th percentile that underwent tonsillectomy March 1, 2011 to July 15, 2020 were included. The study excluded patients with comorbidities that warranted admission independent of BMI, including Trisomy 21, gross developmental delay, neuromuscular disorders, and congenital heart disease. Perioperative AREs following tonsillectomy were recorded. AREs were defined as postoperative desaturation (SpO2 < 90%), intubation, continuous positive airway pressure (CPAP), or new O2 requirement for >2 hours.
Results:
Eighteen patients (8%) had at least 1 ARE. There were no children age 5 and older with a BMI 95th percentile to 98.9th percentile who had an early adverse respiratory outcome. Preoperative polysomnogram (PSG) metrics, obstructive apnea-hypopnea index (oAHI), and oxygen saturations (SpO2) nadir was significantly different between patients with and without AREs (mean oAHI 54.3 vs 17.4, P = .02; mean SpO2 nadir 73.1% vs 84.5%, P = .05). There was no significant difference in the BMI z score (2.88 vs 2.45, P = .09) between groups.
Conclusion:
AREs requiring inpatient management are uncommon in obese children after tonsillectomy. BMI is a poor independent indication for admission except at BMI extremes. We found significantly higher oAHI and lower SpO2 nadir on PSG indicate a higher risk for AREs and can guide admission postoperatively. There may be a subset of obese tonsillectomy patients who can be safely discharged home on the day of surgery.
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