title: Is routine pre-operative cardiac evaluation necessary in obese children undergoing adenotonsillectomy for OSA?
abstract: BACKGROUND
  Adenotonsillectomy (T&A) is a common surgery performed for obstructive sleep apnea (OSA) in children. Obese children are at increased risk for OSA, but are also at increased risk for cardiovascular changes that might heighten their risk of undergoing a general anesthetic. There is currently no standard of care recommendation for cardiac workup prior to T&A.
  
  
  OBJECTIVE
  To ascertain whether a preoperative cardiac workup is predictive of postoperative complications in obese children undergoing T&A for OSA.
  
  
  METHODS
  Retrospective cohort review.
  
  
  METHODS
  241 children with BMI ≥ 25 kg/m(2) underwent T&A for OSA. This cohort was divided into three groups - those who had no preoperative cardiac evaluation, those who had a preoperative cardiac evaluation but no significant findings and those who had a preoperative cardiac evaluation with at least one significant finding. Postoperative cardiac-related complications were compared between the three groups.
  
  
  RESULTS
  There were significantly more postoperative complications in Group 3, the group with findings on preoperative cardiac evaluation. However, these were heavily weighted toward "hospital stay > 24 hours" without clear cardiac sequelae. Notably there were no incidents of pulmonary edema, re-intubation postoperatively or death.
  
  
  CONCLUSIONS
  In obese children undergoing T&A at a tertiary care center, a preoperative cardiac workup was not shown to be beneficial in predicting postoperative complications.
authors.affiliation: Division of Pediatric Otolaryngology, Texas Children's Hospital, Bobby Alford Department of Otolaryngology, Baylor College of Medicine, 6701 Fannin St., Suite 640, Houston, TX, USA. Electronic address: drlarrie@texaschildrens.org.
authors.forename: Deidre R
authors.initials: DR
authors.lastname: Larrier
authors.affiliation: Bobby Alford Department of Otolaryngology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Zhen J
authors.initials: ZJ
authors.lastname: Huang
authors.affiliation: Texas Children's Hospital Outcomes and Impact Service, Texas Children's Hospital, Houston, TX, USA.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Omaha, NE, USA.
authors.forename: Catherine H
authors.initials: CH
authors.lastname: McHugh
authors.affiliation: Division of Pediatric Otolaryngology, Texas Children's Hospital, Houston, TX, USA; Department of Surgery, Texas Children's Hospital, Houston, TX, USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Brock
authors.affiliation: Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
authors.forename: S Chandra-Bose
authors.initials: SC
authors.lastname: Reddy
mesh_terms: D000233:Adenoidectomy; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004452:Echocardiography; D004562:Electrocardiography; D006801:Humans; D007902:Length of Stay; D063766:Pediatric Obesity / Q000150:complications*; D011183:Postoperative Complications; D011300:Preoperative Care; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D014068:Tonsillectomy