title: Postoperative respiratory complications and recovery in obese children following adenotonsillectomy for sleep-disordered breathing: a case-control study.
abstract: 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.
authors.affiliation: Pediatric Otolaryngology, Division of Pediatric Surgery, The Stollery Children's Hospital, Edmonton, Alberta, Canada. elainefung_1@yahoo.com
authors.forename: Elaine
authors.initials: E
authors.lastname: Fung
authors.forename: Dominic
authors.initials: D
authors.lastname: Cave
authors.forename: Manisha
authors.initials: M
authors.lastname: Witmans
authors.forename: Kenton
authors.initials: K
authors.lastname: Gan
authors.forename: Hamdy
authors.initials: H
authors.lastname: El-Hakim
mesh_terms: 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