title: Association of high body mass index in children with early post-tonsillectomy pain.
abstract: BACKGROUND
  The purpose of this investigation was to determine whether there is an association between high body mass index (BMI) in children and the occurrence of early post-tonsillectomy pain (PTP). The hypothesis tested was that high BMI is associated with increased severity of early PTP.
  
  
  METHODS
  We extracted data on all children aged 3-17 years that underwent adeno-tonsillectomy (T&A) over a 2-year period from our anesthesia clinical information system. Patients were classified into normal or high BMI group and early PTP scores were compared between the groups. Clinically significant (moderate-severe) early PTP was defined as pain score ≥ 4 within the first 15 min of admission to the post-anesthesia care unit (PACU).
  
  
  RESULTS
  Among 462 patients, 35.1% were overweight or obese. The overall incidence of moderate to severe early PTP was 23.6%. All the patients received at least one or more intraoperative opioid (morphine 94.2% and fentanyl 21.9%). Compared to those in the normal BMI group, children with moderate-severe PTP were older, female and more likely to be overweight or obese. Children with high BMI had significantly higher unadjusted odds of having moderate-severe early post-tonsillectomy pain (48.9% vs. 14.1%, OR=7.01, 95% CI=3.9-12.8, p<0.001). After controlling for several clinically relevant covariates, high BMI was the most consistent risk factor for moderate to severe early PTP in this cohort of children.
  
  
  CONCLUSIONS
  These results indicate that high BMI in children is associated with increased early PTP. The mechanism(s) underlying this association deserve further elucidation.
authors.affiliation: Department of Anesthesiology, University of Michigan, Ann Arbor, MI 48109-0048, USA. onafiu@med.umich.edu
authors.forename: Olubukola O
authors.initials: OO
authors.lastname: Nafiu
authors.forename: Amy
authors.initials: A
authors.lastname: Shanks
authors.forename: Samir
authors.initials: S
authors.lastname: Abdo
authors.forename: Emma
authors.initials: E
authors.lastname: Taylor
authors.forename: Theodore T
authors.initials: TT
authors.lastname: Tremper
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009765:Obesity / Q000150:complications* / Q000453:epidemiology; D050177:Overweight / Q000150:complications* / Q000453:epidemiology; D010147:Pain Measurement; D010149:Postoperative Pain; D012307:Risk Factors; D014068:Tonsillectomy / Q000009:adverse effects*