title: Perioperative outcomes of severely obese children undergoing tonsillectomy.
abstract: BACKGROUND
  Sleep-disordered breathing, a common condition in obese children, is a frequent indication for tonsillectomy.
  
  
  OBJECTIVE
  The purpose of this study was to examine the association between obesity and perioperative complications in children undergoing tonsillectomy.
  
  
  METHODS
  A sample of 100 severely obese children (body mass index for age [BMIA], ≥ 98 th percentile) between ages 2 and 18 years who underwent tonsillectomy at Mayo Clinic Rochester was randomly selected. Each severely obese child was age (± 2 years) and sex matched to two normal weight children (BMIA between 25th and 75th percentiles) undergoing tonsillectomy during the study period, and their medical records were reviewed.
  
  
  RESULTS
  Severely obese children had a significantly higher incidence of comorbid conditions including respiratory disorders and severe systemic disorders or syndromes. Severely obese children had a higher frequency of perioperative airway complications (15.0% vs 2.0%). From posthoc analyses, severe obesity remained a significant risk factor for perioperative adverse events after adjusting for the presence of severe systemic disorders or syndromes (OR 8.8; 95% CI 2.8-27.5, P < 0.001) and also after adjusting for preoperative respiratory disorders (OR 7.7; 95% CI 2.5-24.3, P < 0.001). When children with planned admissions were excluded from the analysis, severe obesity was associated with an increased rate of unplanned hospital admission (OR 3.80, 95% CI 1.8-7.9, P < 0.001).
  
  
  CONCLUSIONS
  Severe obesity in children undergoing tonsillectomy is independently associated with an increased risk of perioperative complications. It appears that both severe obesity and systemic comorbid condition contribute to higher proportions of inpatient tonsillectomies performed in our institution.
authors: Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA.
authors: Stephen J
authors: SJ
authors: Gleich
authors: Michael D
authors: MD
authors: Olson
authors: Juraj
authors: J
authors: Sprung
authors: Toby N
authors: TN
authors: Weingarten
authors: Darrell R
authors: DR
authors: Schroeder
authors: David O
authors: DO
authors: Warner
authors: Randall P
authors: RP
authors: Flick
mesh_terms: D000293:Adolescent; D058109:Airway Management; D000762:Anesthesia Recovery Period; D000769:Anesthesia, Inhalation; D000771:Anesthesia, Intravenous; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications / Q000453:epidemiology*; D008297:Male; D009765:Obesity / Q000150:complications*; D009767:Obesity, Morbid / Q000150:complications; D010343:Patient Admission; D019990:Perioperative Care; D011183:Postoperative Complications / Q000453:epidemiology*; D012306:Risk; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000601:surgery; D014068:Tonsillectomy; D016896:Treatment Outcome; D055815:Young Adult