Postoperative respiratory complications and recovery in obese children following adenotonsillectomy for sleep-disordered breathing: a case-control study.
OBJECTIVE
To compare postoperative respiratory complications in obese and nonobese children following surgery for sleep-disordered breathing.


METHODS
Case-control study.


METHODS
Pediatric tertiary care center.


METHODS
All obese children who had undergone adenotonsillectomy for sleep-disordered breathing from 2002 to 2007 were compared with age- and gender-matched controls. Subjects were identified from a prospective surgical database. Length of hospital stay and the incidence, severity, and location of respiratory complications were compared. Multivariable analysis was performed to identify predictive factors.


RESULTS
Forty-nine obese children were identified (20:29, female:male). There were no differences in mean age or type of surgical procedures (P > 0.05). Overall, 37 obese children (75.5%) and 13 controls (26.5%) incurred complications (P = 0.000, OR 8.54 [95% CI 3.44-21.19]). Ten obese patients and two controls incurred major events (P = 0.012, OR 6.03 [95% CI 1.25-29.15]); 36 obese children had minor complications versus 12 controls (P = 0.000, OR 8.54 (95% CI 3.44-21.19). Obese children had significantly more upper airway obstruction (19 vs 4, P = 0.0003, OR 7.13 [95% CI 2.20-23.03]), particularly during the immediate postoperative period. The mean hospital stay was significantly longer for the obese group (18 vs 8 hours, P = 0.000, mean difference of 10 hours [95% CI 2.01-17.99]). Male gender, tonsillectomy, and body mass index were significant predictive factors.


CONCLUSIONS
Obesity in children significantly increases the risk of respiratory complications following surgery for sleep-disordered breathing. Overnight hospitalization for obese children is recommended.
Fung
Elaine
E
Pediatric Otolaryngology, Division of Pediatric Surgery, The Stollery Children's Hospital, Edmonton, Alberta, Canada. elainefung_1@yahoo.com
Cave
Dominic
D
Witmans
Manisha
M
Gan
Kenton
K
El-Hakim
Hamdy
H
D000234:Adenoids / Q000601:surgery*; D015992:Body Mass Index; D016022:Case-Control Studies; D002648:Child; D005260:Female; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D009765:Obesity / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology; D012120:Respiration Disorders / Q000453:epidemiology*; D012891:Sleep Apnea Syndromes / Q000453:epidemiology* / Q000601:surgery*; D014068:Tonsillectomy; D016896:Treatment Outcome