Post-tonsillectomy Respiratory Complications in Children With Obesity: Systematic Review and Meta-analysis

To quantify and compare the risk of respiratory complications between children with and without obesity after tonsillectomy (with or without adenoidectomy).

Ovid MEDLINE, Embase, CINAHL, and Clarivate Web of Science.

Studies that reported post-tonsillectomy respiratory complications in patients <18 years old were included. Quality assessment was performed using National Heart, Lung, and Blood Institute quality assessment tools. Meta-analysis of odds ratios with 95% confidence interval (CI) was calculated using random-effects models. Subgroup analyses divided studies by phase of care of event (inpatient only vs post-anesthesia care unit [PACU] or inpatient), indication for tonsillectomy (any vs only sleep-disordered breathing), and medical complexity (>20% with medical comorbidity vs ≤20%).

In total, 18 studies representing 60,044 patients were included. The mean age at surgery ranged from 4.0 to 9.2 years, and 7.8% were obese (>95th body mass index percentile for age and weight). The overall frequency of complications was 8.0%: 12.2% in children with obesity and 7.6% in children without. Compared to children without, those with obesity had significantly increased odds of a complication (odds ratio [OR] 1.86 [95% CI 1.38-2.49, I² = 77.5%]). Obesity did not increase the odds among studies that excluded PACU complications.

Pediatric patients with obesity have nearly twice the odds of post-tonsillectomy respiratory complications than those without. However, odds were elevated only in studies that included events in PACU but not in studies limited to the inpatient wards. Discharge may be safe for children with obesity who do not develop complications in PACU.