Adenoid regrowth and obesity in a longitudinal pediatric cohort

This study aims to elucidate the association between pediatric obesity and revision adenoidectomy in a cohort with longitudinal care needs.

Data were collected via chart review from a tertiary pediatric hospital for patients who underwent adenoidectomy from January 2015 to January 2016 and had 2 years of post-operative follow-up. Demographic, surgical, and clinical data were analyzed using logistic and Cox regression models to identify factors affecting the likelihood and timing of revision adenoidectomy.

Of 461 patients, 115 (24.9 %) were obese at primary intervention. Secondary intervention was performed for 136 patients (29.5 %), with a median interval of 29 months between procedures. In the logistic regression, predictors of revision included younger age at primary intervention (OR = 0.844, p = 0.002), adenoidectomy over adenotonsillectomy as the initial surgery (OR = 0.3, p < 0.001), higher BMI percentile (OR = 1.008, p = 0.048), and allergic rhinitis (OR = 1.722, p = 0.039). In the Cox regression, hazard was lower with adenotonsillectomy (HR = 0.358, p < 0.001), older age at initial surgery (HR = 0.858, p = 0.001), and GERD (HR = 0.595, p = 0.05), but higher with laryngomalacia/tracheomalacia (HR = 1.909, p = 0.034). BMI percentile was not associated with revision timing in the Cox model. Model concordance was 0.694.

Odds of revision adenoidectomy in this population are increased with higher BMI percentile, younger age at primary intervention, undergoing initial adenoidectomy rather than adenotonsillectomy, and various comorbidities, with differing time-dependent effects. These findings support the potential role of obesity-related inflammation in adenoid hypertrophy and individualized surgical decision-making in pediatric patients with sleep disordered breathing.