Adenotonsillectomy in the morbidly obese child

Objective: The prevalence of obesity in the pediatric population has risen more than 20% in 25 years. Accordingly, surgical procedures on obese children have become more common. Adenotonsillectomy (AT) remains among the most frequently performed pediatric surgical procedures in the United States. Our objective was to determine if there is an increased complication rate in morbidly obese (MO) children undergoing AT and if elective pediatric intensive care unit (PICU) admission for observation is warranted. Methods: This retrospective study includes postoperative admissions to the PICU over a 4-year period at one hospital. Out of 957 adenotonsillectomies performed by one surgeon, 543 were admitted to the hospital. Fourteen MO children were identified. Using body mass index (BMI; weight in kg/m 2), as calculated for age appropriate categories, postoperative outcomes of AT in MO children (>95th percentile BMI) were determined. These 14 were electively admitted to the PICU for airway observation. The indication for surgery in these 14 children was obstructive sleep apnea. Ages ranged from 4 to 15 years. There were 11 males and 3 females. Results: Two patients required overnight bi-level positive airway pressure (BiPAP) for oxygen desaturation. One patient remained intubated for 10 days. Three patients required supplemental oxygen. Four of these admissions had preoperative polysomnograms (PSGs). Conclusions: Our study concluded that routine PICU admission was not warranted for most MO patients although several required supplemental oxygen, BiPAP, and one required intubation. These interventions can easily be administered in a surgical floor bed. In fact, these results imply that performing this surgical procedure in obese children is not as risky as many believe. Trends were noted for an increased need of airway interventions in children requiring preoperative BiPAP and in those with comorbidities. In this small population, sample AT was performed on the basis of history. This is to serve as a pilot review for a prospective study in which preoperative PSGs would be used to determine potential indicators for elective PICU admission.