Author(s)
Kathryn Bradburn Wie, MD
Sarah Hancock
Nathan Vandjelovic, DO
Margo McKenna, MD
John Faria, MD
Affiliation(s)
University of Rochester Medical Center; University of Wisconsin-Milwaukee;
Abstract:
Introduction: Obesity has not been studied as an independent risk factor for early respiratory complications following tonsillectomy in pediatric patients, and admission practices vary amongst otolaryngologists. In this case series, we evaluated respiratory outcomes in obese pediatric patients post-tonsillectomy and described the characteristics of patients who suffered early adverse respiratory events (ARE).
Methods: This is a case series of patients 3-12 years of age who underwent tonsillectomy with or without adenoidectomy from 3/1/2011-7/15/2020 at a single tertiary care center. Patients with a BMI >95th %ile were admitted per institution protocol and included in this study. Exclusion criteria consisted of medical conditions that warrant admission regardless of BMI, including Trisomy 21, gross developmental delay, neuromuscular disorders, and congenital heart disease. Chart review was conducted to identify Adverse Respiratory Events (ARE), defined as postoperative desaturation (SpO2<90%), intubation, CPAP, or new O2 requirement for >2h.
Results: 208 patients met inclusion criteria for this study. 17 patients (8.17%) had at least 1 ARE. Of these 17 patients, 7 resolved without intervention, 8 required noninvasive supplemental oxygen >2h, and 2 had significant events, specifically pulmonary edema and inpatient initiation of CPAP. Preoperative PSGs were available for 11/17 subjects with ARE and 113/191 subjects without ARE. The preoperative oAHI and SpO2 nadir were significantly different between patients who had an ARE and those who did not (mean oAHI 54.3 vs. 17.4, p=0.02) (mean SpO2 nadir 71.2% vs. 84.38%, p=0.05). There was no significant difference in the BMI between the groups ( 30.33 vs. 27.29, p=0.14).
Conclusions: While early respiratory complications requiring inpatient management are relatively uncommon in obese children, there are specific characteristics that may indicate a higher risk for ARE and need for postoperative admission. In our study, patients with a postoperative ARE had a significantly higher oAHI and lower SpO2 nadir on preoperative PSG, while there was no difference in BMI.