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Key Factors in Weight Gain After Pediatric Tonsillectomy

Key Factors in Weight Gain After Pediatric Tonsillectomy

Studies have indicated that adenotonsillectomy may be associated with significant weight gain after surgery, a problem that can be concerning for both parents and patients. Previous research also suggests that the postoperative weight gain associated with adenotonsillectomy occurs mostly in children who undergo the procedure as treatment for diagnosed obstructive sleep apnea (OSA). “Potentially worrisome weight gains following adenotonsillectomy occurred primarily in children under the age of 6 years who were underweight or normal weight to begin with.” At the 2012 annual meeting of the American Academy of Otolaryngology–Head and Neck Surgeons, my colleagues and I presented data from a study involving a large population of children undergoing adenotonsillectomy and the demographic factors that may contribute to weight gain. We analyzed medical records of children aged 6 months to 18 years who had their tonsils removed between 2008 and 2011. These data were then refined to only include medical records for children who were routinely examined for at least 6 months after their surgery and had recorded height and weight measurements. All patients in the study had a history of OSA or recurrent tonsillitis. Who’s At Risk for Weight Gain? Results of our analysis showed that, on average, patients had a weight gain of 0.5 to 2.0 lbs— equivalent to a 0.4- to 0.6-point increase in BMI scores—after their surgery. Importantly, the gains that were observed were not dependent on whether the children had OSA or recurrent tonsillitis. In a multiple linear regression analysis that controlled for gender and height, only age was significantly and negatively associated with changes in BMI. Potentially worrisome weight gains following adenotonsillectomy occurred primarily...

Overnight Admissions After Younger Pediatric Tonsillectomy

In 1996, the American Academy of Pediatrics and the American Academy of Otolaryngology—Head and Neck Surgery (AAOHNS) released guidelines indicating that children younger than 3 be admitted overnight for postoperative observation. Studies had shown that young patients were at greater risk for postoperative complications that required readmission and inpatient care. Newer surgical techniques for tonsillectomy have helped to decrease the incidence of primary hemorrhage and shorten recovery time. More recent studies looking at complications with tonsillectomy in the very young—in addition to institutional and personal experiences in the operative setting—have caused some clinicians to question the need for overnight admission in these patients. In our experience, many patients who were electively admitted overnight met all of the criteria to be discharged home within 6 hours of their surgery.  A New Retrospective Review of Tonsillectomy More data are needed to establish an evidence-based justification for challenging the longstanding guidelines from AAOHNS. In the March 19, 2012 Archives of Otolaryngology—Head & Neck Surgery, my colleagues and I had a study published in which we retrospectively examined the outcomes of tonsillectomy performed in children under the age of 3. We recorded the complications they experienced. Among the 86 patients whose medical records were reviewed, 80 (93.0%) did not experience any intraoperative or postoperative complications. Complications after tonsillectomies were generally mild and typically linked to dehydration. Our study’s overall complication rate was beneath the 10% ceiling that has been deemed acceptable for ambulatory procedures by some in the field. Results from another study have reinforced our findings. Key Contributors for Success in Young Children Several factors likely contributed to the low rate of...

Tonsillectomy Guidelines for Children

Approximately 530,000 tonsillectomies are performed each year in the United States, making these surgeries the second most routinely performed operation on children. The two most com­mon indications for tonsillectomy are recurrent throat infections and sleep-disordered breathing (SDB). The overall incidence rate of tonsillectomy appears to have significantly increased in the past 35 years, with SDB as the primary indication for surgery. Children with SDB have a significantly higher rate of antibiotic use, 40% more hospital visits, and a 215% higher rate of healthcare usage. A growing body of evidence indicates that tonsillectomy is an effective treatment for resolving SDB and improving quality of life (QOL). In an issue of Otolaryngology–Head and Neck Surgery, the American Academy of Otolaryngology–Head and Neck Surgery published a multidis­ciplinary clinical practice guideline on tonsillectomy in children. “It’s important that clinicians have evidence-based guidelines for these procedures so that they will be empowered to help patients make the best treatment decisions,” says Reginald F. Baugh, MD, who chaired the guideline committee. “The goals of the guidelines are to make surgery safer and to improve QOL for children who undergo tonsillectomy.” The guideline is intended for all clinicians who care for children between the ages of 1 and 18 being considered for tonsillectomy. It helps identify children who are the best candidates for tonsillectomy. It also provides information on peri­operative care, management options for special patient populations, and counseling strategies. Guideline Recommendations for Tonsillectomy The clinical practice guidelines for tonsillectomy in children outlined 10 specific recommendation state­ments to assist clinicians who manage these patients (Table 1). The statements describe specific aspects to consider with regard to surgical indications...

Pediatric Surgery: Analyzing Informed Consent

When performing surgery in adults, the processes preceding the operation are often routine for surgeons and patients, but surgery is anything but routine for parents of pediatric patients undergoing surgery. Parents and guardians typically lack the experience and expertise of surgeons. As such, trust must be developed between surgeons and parents and/or guardians. To ensure that this trust is attained,...
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