Impact of Obesity on Operative Time in Pediatric Adenotonsillectomy

IntroductionFew studies have analyzed the operative length of pediatric adenotonsillectomy (AT) due to obesity. This study bridges this gap by characterizing differences in operative times associated with AT in pediatric patients with and without obesity.MethodsThis retrospective study included demographic and clinical data for patients aged 3 to 17 years who underwent an AT between February and December 2016. Induction time, time required to complete the AT (operative time), time from procedure completion until extubation (emergence time), and total time spent in the operating room (OR) were determined. Two-sample t-tests and Pearson's tests were used to compare patient data by obesity. Multivariable linear regressions were performed to compare outcome variables by demographic and clinical variables.ResultsOur study included 499 patients with an average age of 7.0±3.6 years. Three hundred sixty-three (73%) patients were not obese, and 136 (27%) patients were obese. Obese patients were more likely than non-obese patients to be older (median [IQR]: 8 [6-10] years old vs 6 [4-9] years old, p<0.001) and exhibit asthma or reactive airway disease (30.9% vs 17.4%, p=0.001) but less likely to have private insurance (22.1% vs 33.6%, p=0.012) or identify as White (66.9% vs 77.4%, p=0.017). Obese patients exhibited higher induction time (13.5±4.0 minutes vs 15.2±4.4 minutes, p<0.0001), operative time (18.0±9.6 minutes vs 21.1±10.1 minutes, p=0.001), emergence time (9.27±5.0 minutes vs 11.8±6.6 minutes, p<0.0001), and total OR time (40.7±12.1 minutes vs 48.1±13.4 minutes, p<0.0001). On multivariable linear regression, obesity was associated with higher induction time (β [95% CI]: 1.69 [0.84, 2.54], p<0.001), operative time (β [95% CI]: 2.37 [0.38, 4.36], p=0.020), emergence time (β [95% CI]: 2.21 [1.08, 3.33], p<0.001), and total OR time (6.27 [3.74, 8.80], p<0.001).ConclusionOur results suggest that obesity is associated with increased AT operative times, thereby impacting appropriate scheduling and perioperative counseling.