Postoperative complications in obese children undergoing adenotonsillectomy

Objective: The incidence of obesity in the pediatric population is increasing. To date, data are limited regarding safety of adenotonsillectomy in this patient population. The purpose of this study is to assess perioperative outcomes of adenotonsillectomy in the obese pediatric patient.

Methods: A review of the 2012 Kids' Inpatient Database (KID) was conducted to compare patients with clinical modification codes for adenotonsillectomy plus obesity to patients with clinical modification codes for adenotonsillectomy alone. Elements for comparison included patient demographics and concurrent discharge. An in depth review of risk factors associated with respiratory complications in obese patients was also conducted.

Results: A weighted total of 899 obese and 20,535 non-obese patients admitted after adenotonsillectomy were identified. When these two groups were compared, respiratory complications were found in 16.2% of obese and 9.6% of non-obese patients (p<0.0001). A diagnosis of respiratory failure or pulmonary insufficiency was statistically more common in obese patients when compared to non-obese patients (5.0% versus 3.0%, p=0.007). In obese patients, respiratory complications were associated with male gender, low income, and concomitant asthma on multivariate analysis (p=0.01, 0.004, and 0.007 respectively).

Conclusion: Performing adenotonsillectomy on the obese pediatric patient is safe. When performing adenotonsillectomy on this patient population, one must be aware that respiratory events are the most common type of complication and risk of respiratory complications is higher in males, patients of low socioeconomic status, and patients with comorbid asthma, regardless of race or insurance status.