1
|
Brennan MP, Webber AM, Patel CV, Chin WA, Butz SF, Rajan N. Care of the Pediatric Patient for Ambulatory Tonsillectomy With or Without Adenoidectomy: The Society for Ambulatory Anesthesia Position Statement. Anesth Analg 2024; 139:509-520. [PMID: 38517763 DOI: 10.1213/ane.0000000000006645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
The landscape of ambulatory surgery is changing, and tonsillectomy with or without adenoidectomy is one of the most common pediatric surgical procedures performed nationally. The number of children undergoing tonsillectomy on an ambulatory basis continues to increase. The 2 most common indications for tonsillectomy are recurrent throat infections and obstructive sleep-disordered breathing. The most frequent early complications after tonsillectomy are hemorrhage and ventilatory compromise. In areas lacking a dedicated children's hospital, these cases are managed by a nonpediatric specialized anesthesiologist and general otolaryngology surgeon. In response to requests from our members without pediatric fellowship training and/or who care for pediatric patients infrequently, the Pediatric Committee of the Society for Ambulatory Anesthesia (SAMBA) developed a position statement with recommendations for the safe perioperative care of pediatric patients undergoing tonsillectomy with and without adenoidectomy in freestanding ambulatory surgical facilities. This statement identifies children that are more likely to experience complications and to require additional dedicated provider time that is not conducive to the rapid pace and staffing ratios of many freestanding ambulatory centers with mixed adult and pediatric practices. The aim is to provide health care professionals with practical criteria and suggestions based on the best available evidence. When high-quality evidence is unavailable, we relied on group consensus from pediatric ambulatory specialists in the SAMBA Pediatric Committee. Consensus recommendations were presented to the Pediatric Committee of SAMBA.
Collapse
Affiliation(s)
- Marjorie P Brennan
- From the Department of Anesthesiology, Pain and Perioperative Medicine, The George Washington University School of Medicine, Children's National Hospital, Washington, DC
| | - Audra M Webber
- University of Rochester School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York
| | - Chhaya V Patel
- Department of Anesthesiology and Pediatrics, Emory School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Wanda A Chin
- Department of Anesthesiology and Perioperative Medicine, New York University Grossman School of Medicine, NYU Lagone Health, New York, New York
| | - Steven F Butz
- Department of Anesthesiology, Medical College of Wisconsin, Children's Wisconsin Surgicenter
| | - Niraja Rajan
- Department of Anesthesiology, Penn State Milton S Hershey Medical Center, Hershey Outpatient Surgery Center, Hershey, Pennsylvania
| |
Collapse
|
2
|
Martin E, Frank M, Nguyen C, Bhatt J, Huoh K, Ahuja G, Pham N. Supplemental oxygen requirement after tonsillectomy in children >3 years of age. Int J Pediatr Otorhinolaryngol 2024; 178:111893. [PMID: 38382259 DOI: 10.1016/j.ijporl.2024.111893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/01/2024] [Accepted: 02/07/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION The indications for postoperative admission after tonsillectomy in children >3 years of age are less well defined than for children <3 years old, and typically include severe obstructive sleep apnea (OSA), obesity, comorbidities, or behavioral factors. Inpatient care after tonsillectomy typically consists of respiratory monitoring and support, as respiratory compromise is the most common complication after pediatric tonsillectomy. We aim to evaluate risk factors associated with postoperative oxygen supplementation and to identify high risk populations within the admitted population who use additional resources or require additional interventions. METHODS Retrospective chart review of patients between the ages of 3 and 18 years old who underwent tonsillectomy by four surgeons at a tertiary care children's hospital was performed. Data including demographics, comorbidities, surgical intervention, pre- and postoperative AHI, admission, postoperative oxygen requirement, and postoperative complications was collected and analyzed. RESULTS There were 401 patients included in the analysis. Of the patients in this study, 65.59% were male, 43.39% were Latino, and 53.87% were ages 3 to 7. Of the 397 patients with a record for supplemental oxygen, 36 (9.07%) received supplemental oxygen. The LASSO regression odds ratios (OR) found to be important for modeling supplemental oxygen use (in decreasing order of magnitude) are BMI ≥35 (OR = 2.30), pre-op AHI >30 (OR = 2.28), gastrointestinal comorbidities (OR = 2.20), musculoskeletal comorbidities (OR = 1.91), cardiac comorbidities (OR = 1.20), pulmonary comorbidities (OR = 1.14), and BMI 30 to <35 (OR = 1.07). Female gender was found to be negatively associated with risk of supplemental oxygen use (OR = 0.84). Age, race, AHI ≥15-30, neurologic comorbidities, syndromic patients, admission reason, and undergoing other procedures concomitantly were not found to be associated with increased postoperative oxygen requirement. CONCLUSION BMI ≥30, pre-op AHI >30, male gender, and gastrointestinal, musculoskeletal, cardiac, and pulmonary comorbidities are all associated with postoperative supplemental oxygen use. Age, race, AHI ≥15-30, neurologic comorbidities, syndromic patients, admission reason, and undergoing other procedures concomitantly were not found to be associated with increased postoperative oxygen requirement.
Collapse
Affiliation(s)
- Elaine Martin
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA.
| | - Madelyn Frank
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA
| | - Cecilia Nguyen
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Orange, CA, USA
| | - Jay Bhatt
- Department of Pediatric Otolaryngology - Head & Neck Surgery, Children's Hospital of Orange County, Orange, CA, USA
| | - Kevin Huoh
- Department of Pediatric Otolaryngology - Head & Neck Surgery, Children's Hospital of Orange County, Orange, CA, USA
| | - Gurpreet Ahuja
- Department of Pediatric Otolaryngology - Head & Neck Surgery, Children's Hospital of Orange County, Orange, CA, USA
| | - Nguyen Pham
- Department of Pediatric Otolaryngology - Head & Neck Surgery, Children's Hospital of Orange County, Orange, CA, USA
| |
Collapse
|
3
|
Gladen KM, Tellez D, Napolitano N, Edwards LR, Sanders RC, Kojima T, Malone MP, Shults J, Krawiec C, Ambati S, McCarthy R, Branca A, Polikoff LA, Jung P, Parsons SJ, Mallory PP, Komeswaran K, Page-Goertz C, Toal MC, Bysani GK, Meyer K, Chiusolo F, Glater-Welt LB, Al-Subu A, Biagas K, Hau Lee J, Miksa M, Giuliano JS, Kierys KL, Talukdar AM, DeRusso M, Cucharme-Crevier L, Adu-Arko M, Shenoi AN, Kimura D, Flottman M, Gangu S, Freeman AD, Piehl MD, Nuthall GA, Tarquinio KM, Harwayne-Gidansky I, Hasegawa T, Rescoe ES, Breuer RK, Kasagi M, Nadkarni VM, Nishisaki A. Adverse Tracheal Intubation Events in Critically Ill Underweight and Obese Children: Retrospective Study of the National Emergency Airway for Children Registry (2013-2020). Pediatr Crit Care Med 2024; 25:147-158. [PMID: 37909825 PMCID: PMC10841296 DOI: 10.1097/pcc.0000000000003387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
OBJECTIVES Extremes of patient body mass index are associated with difficult intubation and increased morbidity in adults. We aimed to determine the association between being underweight or obese with adverse airway outcomes, including adverse tracheal intubation (TI)-associated events (TIAEs) and/or severe peri-intubation hypoxemia (pulse oximetry oxygen saturation < 80%) in critically ill children. DESIGN/SETTING Retrospective cohort using the National Emergency Airway for Children registry dataset of 2013-2020. PATIENTS Critically ill children, 0 to 17 years old, undergoing TI in PICUs. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Registry data from 24,342 patients who underwent TI between 2013 and 2020 were analyzed. Patients were categorized using the Centers for Disease Control and Prevention weight-for-age chart: normal weight (5th-84th percentile) 57.1%, underweight (< 5th percentile) 27.5%, overweight (85th to < 95th percentile) 7.2%, and obese (≥ 95th percentile) 8.2%. Underweight was most common in infants (34%); obesity was most common in children older than 8 years old (15.1%). Underweight patients more often had oxygenation and ventilation failure (34.0%, 36.2%, respectively) as the indication for TI and a history of difficult airway (16.7%). Apneic oxygenation was used more often in overweight and obese patients (19.1%, 19.6%) than in underweight or normal weight patients (14.1%, 17.1%; p < 0.001). TIAEs and/or hypoxemia occurred more often in underweight (27.1%) and obese (24.3%) patients ( p < 0.001). TI in underweight children was associated with greater odds of adverse airway outcome compared with normal weight children after adjusting for potential confounders (underweight: adjusted odds ratio [aOR], 1.09; 95% CI, 1.01-1.18; p = 0.016). Both underweight and obesity were associated with hypoxemia after adjusting for covariates and site clustering (underweight: aOR, 1.11; 95% CI, 1.02-1.21; p = 0.01 and obesity: aOR, 1.22; 95% CI, 1.07-1.39; p = 0.002). CONCLUSIONS In underweight and obese children compared with normal weight children, procedures around the timing of TI are associated with greater odds of adverse airway events.
Collapse
Affiliation(s)
- Kelsey M Gladen
- Pediatric Critical Care Medicine, Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ
| | - David Tellez
- Pediatric Critical Care Medicine, Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ
| | - Natalie Napolitano
- Respiratory Therapy Department, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Lauren R Edwards
- Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital and Medical Center, University of Nebraska Medical Center, Omaha, NE
| | - Ronald C Sanders
- Section of Critical Care Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR
| | - Taiki Kojima
- Department of Anesthesiology, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Matthew P Malone
- Section of Critical Care Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR
| | - Justine Shults
- Department of Biostatistics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Conrad Krawiec
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Health Children's Hospital, Hershey, PA
| | - Shashikanth Ambati
- Pediatric Critical Care Medicine, Department of Pediatrics, Albany Medical Center, Albany, NY
| | - Riley McCarthy
- Pediatric Critical Care Medicine, Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ
| | - Aline Branca
- Pediatric Critical Care Medicine, Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ
| | - Lee A Polikoff
- Division of Critical Care Medicine, Department of Pediatrics, The Warren Alpert Medical School at Brown University, Providence, RI
| | - Philipp Jung
- Department of Pediatrics, University Children's Hospital, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Simon J Parsons
- Department of Pediatrics, Section of Critical Care Medicine, Alberta Children's Hospital, Calgary, AB, Canada
| | | | | | - Christopher Page-Goertz
- Pediatric Critical Care Medicine, Department of Pediatrics, Akron Children's Hospital, Akron, OH
| | - Megan C Toal
- Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - G Kris Bysani
- Pediatric Critical Care Medicine, Department of Pediatrics, Medical City Children's Hospital, Dallas, TX
| | - Keith Meyer
- Division of Critical Care Medicine, Nicklaus Children's Hospital, Herber Wertheim College of Medicine Florida International University, Miami, FL
| | - Fabrizio Chiusolo
- Anesthesia and Critical Care Medicine, ARCO, Bambino Gesú Children's Hospital, Rome, Italy
| | - Lily B Glater-Welt
- Division of Pediatric Critical Care, Cohen Children's Medical Center of New York, Queens, NY
| | - Awni Al-Subu
- Pediatric Critical Care Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Katherine Biagas
- Pediatric Critical Care Medicine, Department of Pediatrics, The Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - Jan Hau Lee
- Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore
| | - Michael Miksa
- Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY
| | - John S Giuliano
- Department of Pediatrics, Section of Critical Care Medicine, Yale University School of Medicine, New Haven, CT
| | - Krista L Kierys
- Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Health, Milton S. Hershey Medical Center, Hershey, PA
| | - Andrea M Talukdar
- Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital and Medical Center, University of Nebraska Medical Center, Omaha, NE
| | | | - Laurence Cucharme-Crevier
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Michelle Adu-Arko
- Division of Pediatric Critical Care, Department of Pediatrics, University of Virginia, Charlottesville, VA
| | - Asha N Shenoi
- Pediatric Critical Care Medicine, Department of Pediatrics, University of Kentucky, Lexington, KY
| | - Dai Kimura
- Critical Care Medicine, Department of Pediatrics, Orlando Health Arnold Palmer Hospital for Children, Orlando, FL
| | - Molly Flottman
- Pediatric Critical Care Medicine, Department of Pediatrics, University of Louisville, Norton Children's Hospital, Louisville, KY
| | - Shantaveer Gangu
- Critical Care Medicine, Department of Pediatrics, Orlando Health Arnold Palmer Hospital for Children, Orlando, FL
| | - Ashley D Freeman
- Pediatric Critical Care Medicine, Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, GA
| | - Mark D Piehl
- Pediatric Critical Care Medicine, Department of Pediatrics, WakeMed Children's Hospital, Raleigh, NC
| | - G A Nuthall
- Pediatric Critical Care, Department of Pediatrics, Starship Children's Hospital, Auckland, New Zealand
| | - Keiko M Tarquinio
- Pediatric Critical Care Medicine, Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, Atlanta, GA
| | - Ilana Harwayne-Gidansky
- Pediatric Critical Care Medicine, Department of Pediatrics, Bernard and Millie Duker Children's Hospital, Albany, NY
| | - Tatsuya Hasegawa
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
| | - Erin S Rescoe
- Division of Pediatric Critical Care, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, NY
| | - Ryan K Breuer
- Division of Critical Care Medicine, John R. Oishei Children's Hospital, Buffalo, NY
| | - Mioko Kasagi
- Pediatric Critical Care and Emergency Medicine, Department of Pediatrics, Tokyo Metropolitan Children's Medical Center, Fuchu, Japan
| | - Vinay M Nadkarni
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Akira Nishisaki
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| |
Collapse
|
4
|
Zavras N, Vaou N, Zouganeli S, Kasti A, Dimitrios P, Vaos G. The Impact of Obesity on Perioperative Outcomes for Children Undergoing Appendectomy for Acute Appendicitis: A Systematic Review. J Clin Med 2023; 12:4811. [PMID: 37510927 PMCID: PMC10381702 DOI: 10.3390/jcm12144811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/13/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
Today, the prevalence of obesity in the pediatric population has increased dramatically. Acute appendicitis (AA) is the most common surgical condition among pediatric patients. We aimed to investigate the impact of obesity on postoperative outcomes in terms of operative time (OT), length of stay (LOS), surgical site infection (SSI), overall complications, adverse events, and mortality in children undergoing appendectomy for acute appendicitis. An extensive search of the literature in PubMed and Google Scholar was conducted to evaluate the outcomes of normal weight (NW), overweight (OW), and obese (OB) children who underwent appendectomy. Although no statistically significant differences were noted in perioperative outcomes and overall postoperative complications between OW/OB and NW children in the majority of the included studies, prolonged OT and LOS and SSI were found in some studies. Moreover, no differences in terms of readmissions and ED visits were recorded. We conclude that the impact of obesity on postoperative outcomes for children undergoing appendectomy for AA is unclear, and, therefore, no safe conclusions can be drawn with the currently available data. Due to the lack of high-quality studies, further research is required to optimize the surgical approach and prevent unwarranted complications.
Collapse
Affiliation(s)
- Nikolaos Zavras
- Department of Pediatric Surgery, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, 12462 Athens, Greece
| | - Natalia Vaou
- Department of Nutrition and Dietetics, Attikon University General Hospital, 12462 Athens, Greece
| | - Sofia Zouganeli
- Department of Nutrition and Dietetics, Attikon University General Hospital, 12462 Athens, Greece
| | - Arezina Kasti
- Department of Nutrition and Dietetics, Attikon University General Hospital, 12462 Athens, Greece
| | | | - George Vaos
- Department of Pediatric Surgery, Medical School, National and Kapodistrian University of Athens, Attikon University General Hospital, 12462 Athens, Greece
| |
Collapse
|
5
|
Tram NK, Mpody C, Owusu-Bediako K, Murillo-Deluquez ME, Tobias JD, Nafiu OO. Childhood obesity trends: Association with same-day hospital admission in a National Outpatient Surgical Population. Paediatr Anaesth 2023; 33:312-318. [PMID: 36527422 DOI: 10.1111/pan.14617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/30/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Although the prevalence of obesity in the general population and its perioperative implications among children undergoing inpatient surgeries are well known, little is known about obesity prevalence among children scheduled for ambulatory surgery. AIMS Here, we report the trends of obesity and severe obesity among children who underwent ambulatory surgery across multiple centers in the United States and explore the association of obesity status with admission following elective ambulatory surgery. MATERIALS AND METHODS Using data from the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (2012-2019), we selected children 2-18 years old who underwent outpatient surgical procedures under general anesthesia and had documented height, weight, and body mass index (BMI) data. We estimated the prevalence of overweight, obesity (class 1), and severe obesity (class 2 and class 3) patients and explored their association with same-day hospital admission, defined as hospital length of stay ≥1 day. RESULTS Data from 152 918 children (mean age: 9.7 ± 4.7 years) were analyzed. Of these, 16.4% (n = 25 007) were overweight, 13.8% (n = 21 085) were class 1 obese, 5.2% (n = 7879) were class 2 obese, and 3.0% (n = 4623) were class 3 obese. From 2012 to 2019, class 2 or 3 obesity prevalence increased by 26.7% and 32.5%, respectively. Overweight and obese children had relatively higher odds of same-day hospital admission compared to healthy weight children (overweight odds ratio [95% confidence interval]: 1.05 [1.02, 1.08]; class 1 obesity: 1.04 [1.00, 1.07]; class 2 obesity: 1.09 [1.02, 1.16]; class 3 obesity: 1.20 [1.11, 1.30]). DISCUSION AND CONCLUSION The burden of obesity continues to increase in children scheduled for ambulatory surgery. Children with class 2 and class 3 obesity have higher rates of same-day hospital admission following elective ambulatory surgery compared to healthy weight children, a factor that should be considered in scheduling these patients.
Collapse
Affiliation(s)
- Nguyen K Tram
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Anesthesiology & Pain Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Christian Mpody
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Anesthesiology & Pain Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Kwaku Owusu-Bediako
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | | | - Joseph D Tobias
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Anesthesiology & Pain Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Olubukola O Nafiu
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Anesthesiology & Pain Medicine, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
6
|
Effect of Obesity on the Recovery Profile After General Anesthesia in Children: A Prospective Cohort Study. Indian Pediatr 2023. [DOI: 10.1007/s13312-023-2806-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
|
7
|
Daigle CH, Laverriere EK, Bruins BB, Lockman JL, Fiadjoe JE, McGowan N, Napolitano N, Shults J, Nadkarni VM, Nishisaki A. Mitigation and Outcomes of Difficult Bag-Mask Ventilation in Critically Ill Children. J Pediatr Intensive Care 2023. [DOI: 10.1055/s-0042-1760413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
AbstractDifficult bag-mask ventilation (BMV) occurs in 10% of pediatric intensive care unit (PICU) tracheal intubations (TI). The reasons clinicians identify difficult BMV in the PICU and the interventions used to mitigate that difficulty have not been well-studied. This is a prospective, observational, single-center study. A patient-specific data form was sent to PICU physicians supervising TIs from November 2019 through December 2020 to identify the presence of difficult BMV, attempted interventions used, and perceptions about intervention success. The dataset was linked and merged with the local TI quality database to assess safety outcomes. Among 305 TIs with response (87% response rate), 267 (88%) clinicians performed BMV during TI. Difficult BMV was reported in 28 of 267 patients (10%). Commonly reported reasons for difficult BMV included: facial structure (50%), high inspiratory pressure (36%), and improper mask fit (21%). Common interventions were jaw thrust (96%) and an airway adjunct (oral airway 50%, nasal airway 7%, and supraglottic airway 11%), with ventilation improvement in 44% and 73%, respectively. Most difficult BMV was identified before neuromuscular blockade (NMB) administration (96%) and 67% (18/27) resolved after NMB administration. The overall success in improving ventilation was 27/28 (96%). TI adverse outcomes (hemodynamic events, emesis, and/or hypoxemia <80%) are associated with the presence of difficult BMV (10/28, 36%) versus non-difficult BMV (20/239, 8%, p< 0.001). Difficult BMV is common in critically ill children and is associated with increased TI adverse outcomes. Airway adjunct placement and NMB use are often effective in improving ventilation.
Collapse
Affiliation(s)
- C. Hunter Daigle
- Division of Critical Care Medicine, Department of Pediatrics, University of Texas at Austin, Dell Children's Medical Center, Austin, Texas, United States
| | - Elizabeth K. Laverriere
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Benjamin B. Bruins
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Justin L. Lockman
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - John E. Fiadjoe
- Department of Anesthesiology, Critical Care, and Pain Medicine. Boston Children's Hospital. Boston, Massachusetts, United States
| | - Nancy McGowan
- Department of Respiratory Therapy, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Natalie Napolitano
- Department of Respiratory Therapy, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Justine Shults
- Division of Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Vinay M. Nadkarni
- Center for Simulation, Advanced Education and Innovation, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Akira Nishisaki
- Center for Simulation, Advanced Education and Innovation, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | | |
Collapse
|
8
|
Gloff MS, Robinson R, Correll LR, Lander H, Pyne S, Webber A. Preoperative optimization in the pediatric patient. Int Anesthesiol Clin 2022; 60:56-63. [PMID: 34711789 DOI: 10.1097/aia.0000000000000342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Marjorie S Gloff
- Department of Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York
| | | | | | | | | | | |
Collapse
|
9
|
Burton ZA, Lewis R, Bennett T, McLernon DJ, Engelhardt T, Brooks PB, Edwards MR. Prevalence of PErioperAtive CHildhood obesitY in children undergoing general anaesthesia in the UK: a prospective, multicentre, observational cohort study. Br J Anaesth 2021; 127:953-961. [PMID: 34627621 DOI: 10.1016/j.bja.2021.07.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/13/2021] [Accepted: 07/30/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Childhood obesity has become a serious global healthcare challenge. No UK data currently define its anaesthetic and perioperative implications. We aimed to determine obesity prevalence amongst UK children undergoing general anaesthesia and the incidence of predefined adverse perioperative events, and to compare perioperative obesity rates with National Child Measurement Programme (NCMP) data. METHODS During a site-selected consecutive 7-day study period, all children (2-16 yr) undergoing general anaesthesia were included. Anonymised hospital, surgical, and procedural details; demographic data; and adverse perioperative events were collected prospectively by Paediatric Anaesthesia Trainee Research Network (PATRN) collaborators. RESULTS For this study, 102 UK hospitals participated and 4232 cases were included in the final analysis; 76% of hospitals did not routinely calculate BMI. In addition, 3030 (71.6%; 95% confidence interval [CI]: 70.2-73.0%) children of healthy weight were compared with 537 (12.7%; 11.7-13.7%) children who were overweight and 478 (11.3%; 10.3-12.2%) children with obesity. Children with obesity (n=71; 14.9%) more commonly underwent (adeno)tonsillectomy than children of healthy weight (n=282; 9.3%; P<0.001; odds ratio [OR] 2.15; 95% CI: 1.58-2.92). Fewer children with obesity (n=365; 77% vs n=2552; 85%) were anaesthetised by consultant anaesthetists (OR 0.62; 95% CI: 0.48-0.79). Mask ventilation was difficult for 3.7% of children with obesity vs 0.6% of children of healthy weight (difference 3.0%; 95% CI: 1.3-4.7%; P<0.001). Comparison with NCMP data demonstrated an over-representation of obesity amongst the paediatric surgical population. CONCLUSIONS This large multicentre cohort study suggests a concerning prevalence of children with obesity presenting for anaesthesia. These results should be used to inform optimal provision of care for this population and support perioperative healthcare initiatives to address the burden of childhood obesity. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03994419.
Collapse
Affiliation(s)
- Zoë A Burton
- Department of Anaesthesia, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK.
| | - Rosie Lewis
- Department of Anaesthesia, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Tom Bennett
- Department of Anaesthesia, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - David J McLernon
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Thomas Engelhardt
- McGill University Health Center, Montreal Children's Hospital, Montreal, QC, Canada
| | - Peter B Brooks
- Department of Anaesthesia, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Mark R Edwards
- Department of Anaesthesia, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| |
Collapse
|
10
|
Webber AM, Willer BL. Obesity, Race, and Perioperative Complications. CURRENT ANESTHESIOLOGY REPORTS 2021. [DOI: 10.1007/s40140-021-00458-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
11
|
Difficult Bag-Mask Ventilation in Critically Ill Children Is Independently Associated With Adverse Events. Crit Care Med 2021; 48:e744-e752. [PMID: 32590390 DOI: 10.1097/ccm.0000000000004425] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Bag-mask ventilation is commonly used prior to tracheal intubation; however, the epidemiology, risk factors, and clinical implications of difficult bag-mask ventilation among critically ill children are not well studied. This study aims to describe prevalence and risk factors for pediatric difficult bag-mask ventilation as well as its association with adverse tracheal intubation-associated events and oxygen desaturation in PICU patients. DESIGN A retrospective review of prospectively collected observational data from a multicenter tracheal intubation database (National Emergency Airway Registry for Children) from January 2013 to December 2018. SETTING Forty-six international PICUs. PATIENTS Children receiving bag-mask ventilation as a part of tracheal intubation in a PICU. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The primary outcome is the occurrence of either specific tracheal intubation-associated events (hemodynamic tracheal intubation-associated events, emesis with/without aspiration) and/or oxygen desaturation (< 80%). Factors associated with perceived difficult bag-mask ventilation were found using univariate analyses, and multivariable logistic regression identified an independent association between bag-mask ventilation difficulty and the primary outcome. Difficult bag-mask ventilation is reported in 9.5% (n = 1,501) of 15,810 patients undergoing tracheal intubation with bag-mask ventilation during the study period. Difficult bag-mask ventilation is more commonly reported with increasing age, those with a primary respiratory diagnosis/indication for tracheal intubation, presence of difficult airway features, more experienced provider level, and tracheal intubations without use of neuromuscular blockade (p < 0.001). Specific tracheal intubation-associated events or oxygen desaturation events occurred in 40.2% of patients with reported difficult bag-mask ventilation versus 19.8% in patients without perceived difficult bag-mask ventilation (p < 0.001). The presence of difficult bag-mask ventilation is independently associated with an increased risk of the primary outcome: odds ratio, 2.28 (95% CI, 2.03-2.57; p < 0.001). CONCLUSIONS Difficult bag-mask ventilation is reported in approximately one in 10 PICU patients undergoing tracheal intubation. Given its association with adverse procedure-related events and oxygen desaturation, future study is warranted to improve preprocedural planning and real-time management strategies.
Collapse
|
12
|
Pediatric obesity and perioperative medicine. Curr Opin Anaesthesiol 2021; 34:299-305. [PMID: 33935177 DOI: 10.1097/aco.0000000000000991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Childhood obesity is a public health emergency that has reached a pandemic level and imposed a massive economic burden on healthcare systems. Our objective was to provide an update on (1) challenges of obesity definition and classification in the perioperative setting, (2) challenges of perioperative patient positioning and vascular access, (3) perioperative implications of childhood obesity, (3) anesthetic medication dosing and opioid-sparing techniques in obese children, and (4) research gaps in perioperative childhood obesity research including a call to action. RECENT FINDINGS Despite the near axiomatic observation that obesity is a pervasive clinical problem with considerable impact on perioperative health, there have only been a handful of research into the many ramifications of childhood obesity in the perioperative setting. A nuanced understanding of the surgical and anesthetic risks associated with obesity is essential to inform patients' perioperative consultation and their parents' counseling, improve preoperative risk mitigation, and improve patients' rescue process when complications occur. SUMMARY Anesthesiologists and surgeons will continue to be confronted with an unprecedented number of obese or overweight children with a high risk of perioperative complications.
Collapse
|
13
|
Jardaly A, McGwin G, Gilbert SR. Blount Disease and Obstructive Sleep Apnea: An Under-recognized Association? J Pediatr Orthop 2021; 40:604-607. [PMID: 32433261 DOI: 10.1097/bpo.0000000000001591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Obesity is strongly associated with both Blount disease and obstructive sleep apnea (OSA). Obesity increases risks for anesthetic and postoperative complications, and OSA can further exacerbate these risks. Since children with Blount disease might have both conditions, we sought to determine the perioperative complications and the prevalence of OSA among these children. METHODS Patients younger than 18 years undergoing corrective surgery for Blount disease were identified from 2 sources as follows: a retrospective review of records at a single institution and querying of the Kids' Inpatient Database, a nationally representative database. RESULTS At our institution, the prevalence of OSA among patients surgically treated for Blount disease was 23% (42/184). Blount patients were obese (100%), and predominately African American (89%), and male (68%). Patients were treated for OSA before surgery, and 2 patients (1%) had postoperative hypoxemia. In contrast, of 1059 cases of Blount disease from the Kids' Inpatient Database, 3% were diagnosed with OSA. In total, 4.4% of all the Blount children experienced complications, including hypoxemia, respiratory insufficiency, atelectasis, and arrhythmias. Complications were associated with 4.3 additional days of hospitalization (P<0.0001) and 39% additional hospital charges (P=0.002). CONCLUSIONS Data from the national database showed a low rate of OSA prevalence but high respiratory and OSA-associated complications, perhaps indicating that OSA may be underdiagnosed in children with Blount disease. Affected patients, especially ones with untreated OSA, sustain increased surgical morbidity. A high index of suspicion and preoperative planning helps alleviate the burden of OSA among these patients. LEVEL OF EVIDENCE Level III-case-control study.
Collapse
Affiliation(s)
- Achraf Jardaly
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon.,Departments of Orthopedic Surgery
| | - Gerald McGwin
- Departments of Orthopedic Surgery.,Epidemiology, University of Alabama, Birmingham, AL
| | | |
Collapse
|
14
|
Egbuta C, Mason KP. Recognizing Risks and Optimizing Perioperative Care to Reduce Respiratory Complications in the Pediatric Patient. J Clin Med 2020; 9:jcm9061942. [PMID: 32580323 PMCID: PMC7355459 DOI: 10.3390/jcm9061942] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/10/2020] [Accepted: 06/17/2020] [Indexed: 12/19/2022] Open
Abstract
There have been significant advancements in the safe delivery of anesthesia as well as improvements in surgical technique; however, the perioperative period can still be high risk for the pediatric patient. Perioperative respiratory complications (PRCs) are some of the most common critical events that can occur in pediatric surgical patients and they can lead to increased length of hospitalization, worsened patient outcomes, and higher hospital and postoperative costs. It is important to determine the various factors that put pediatric patients at increased risk of PRCs. This will allow for more detailed and accurate informed consent, optimized perioperative management strategy, improved allocation of clinical resources, and, hopefully, better patient experience. There are only a few risk prediction models/scoring tools developed for and validated in the pediatric patient population, but they have been useful in helping identify the key factors associated with a high likelihood of developing PRCs. Some of these factors are patient factors, while others are procedure-related factors. Some of these factors may be modified such that the patient’s clinical status is optimized preoperatively to decrease the risk of PRCs occurring perioperatively. Fore knowledge of the factors that are not able to be modified can help guide allocation of perioperative clinical resources such that the negative impact of these non-modifiable factors is buffered. Additional training in pediatric anesthesia or focused expertise in pediatric airway management, vascular access and management of massive hemorrhage should be considered for the perioperative management of the less than 3 age group. Intraoperative ventilation strategy plays a key role in determining respiratory outcomes for both adult and pediatric surgical patients. Key components of lung protective mechanical ventilation strategy such as low tidal volume and moderate PEEP used in the management of acute respiratory distress syndrome (ARDS) in pediatric intensive care units have been adopted in pediatric operating rooms. Adequate post-operative analgesia that balances pain control with appropriate mental status and respiratory drive is important in reducing PRCs.
Collapse
|
15
|
Covarrubias K, Luo X, Massie A, Schwarz KB, Garonzik-Wang J, Segev DL, Mogul DB. Determinants of length of stay after pediatric liver transplantation. Pediatr Transplant 2020; 24:e13702. [PMID: 32212292 PMCID: PMC7260078 DOI: 10.1111/petr.13702] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/07/2020] [Accepted: 03/04/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND We sought to identify factors that are associated with LOS following pediatric (<18 years) liver transplantation in order to provide personalized counseling and discharge planning for recipients and their families. METHODS We identified 2726 infants (≤24 months) and 3210 children (>24 months) who underwent pediatric liver-only transplantation from 2002-2017 using the Scientific Registry of Transplant Recipients. We used multilevel multivariable negative binomial regression to analyze associations between LOS and recipient and donor characteristics and calculated the MLOSR to quantify heterogeneity in LOS across centers. RESULTS In infants, the median LOS (IQR) was 19 (13-32) days. Hospitalization prior to transplant (ICU ratio:1.46 1.591.70 ; non-ICU ratio:1.08 1.161.23 ), public insurance (ratio:1.03 1.091.15 ), and a segmental graft (ratio:1.08 1.151.22 ) were associated with a longer LOS; thus, we would expect a 1.59-fold longer LOS in an infant admitted to the ICU compared to a non-hospitalized infant with similar characteristics. In children, the median LOS (IQR) was 13 (9-21) days. Hospitalization prior to transplant (ICU ratio:1.49 1.621.77 ; non-ICU ratio:1.34 1.441.56 ), public insurance (ratio:1.02 1.071.13 ), a segmental graft (ratio:1.20 1.271.35 ), a living donor graft (ratio:1.27 1.381.51 ), and obesity (ratio:1.03 1.101.17 ) were associated with a longer LOS. The MLOSR was 1.25 in infants and 1.26 in children, meaning if an infant received a transplant at another center with a longer LOS, we would expect a 1.25-fold difference in LOS driven by center practices alone. CONCLUSIONS While center-level practices account for substantial variation in LOS, consideration of donor and recipient factors can help clinicians provide more personalized counseling for families of pediatric liver transplant candidates.
Collapse
Affiliation(s)
- Karina Covarrubias
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Xun Luo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Allan Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD
| | - Kathleen B. Schwarz
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, MD
| | - Douglas B. Mogul
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
16
|
Aravindan A, Singh AK, Kurup M, Gupta S. Anaesthetic management of paediatric patient with Prader-Willi syndrome for bariatric surgery. Indian J Anaesth 2020; 64:444-445. [PMID: 32724260 PMCID: PMC7286395 DOI: 10.4103/ija.ija_22_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/23/2020] [Accepted: 04/02/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ajisha Aravindan
- Department of Anaesthesia, Pain and Critical Care, All India Institute of Medical Science, New Delhi, India
| | - Ashutosh K Singh
- Department of Anaesthesia, Pain and Critical Care, All India Institute of Medical Science, New Delhi, India
| | - Mahendran Kurup
- Department of Anaesthesia, Pain and Critical Care, All India Institute of Medical Science, New Delhi, India
| | - Shruti Gupta
- Department of Anaesthesia, Pain and Critical Care, All India Institute of Medical Science, New Delhi, India
| |
Collapse
|
17
|
Challenges of pediatric obesity in perioperative care. Int Anesthesiol Clin 2020; 58:9-13. [PMID: 32282576 DOI: 10.1097/aia.0000000000000280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
18
|
Nafiu OO, Owusu-Bediako K, Chiravuri SD. Effect of Body Mass Index Category on Body Surface Area Calculation in Children Undergoing Cardiac Procedures. Anesth Analg 2020; 130:452-461. [DOI: 10.1213/ane.0000000000004016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
19
|
Radman M, McGuire J, Zimmerman J. Childhood Obesity, Endothelial Cell Activation, and Critical Illness. Front Pediatr 2020; 8:441. [PMID: 32850554 PMCID: PMC7419464 DOI: 10.3389/fped.2020.00441] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/25/2020] [Indexed: 12/13/2022] Open
Abstract
Pediatric obesity is increasing in prevalence and is frequently an antecedent to adult obesity and adult obesity-associated morbidities such as atherosclerosis, type II diabetes, and chronic metabolic syndrome. Endothelial cell activation, one aspect of inflammation, is present in the early stages of atherosclerosis, often prior to the onset of symptoms. Endothelial activation is a pathological condition in which vasoconstricting, pro-thrombotic, and proliferative mediators predominate protective vasodilating, anti-thrombogenic, and anti-mitogenic mediators. Many studies report poor outcomes among obese children with systemic endothelial activation. Likewise, the link between childhood obesity and poor outcomes in critical illness is well-established. However, the link between obesity and severity of endothelial activation specifically in the setting of critical illness is largely unstudied. Although endothelial cell activation is believed to worsen disease in critically ill children, the nature and extent of this response is poorly understood due to the difficulty in measuring endothelial cell dysfunction and destruction. Based on the data available for the obese, asymptomatic population and the obese, critically ill population, the authors posit that obesity, and obesity-associated chronic inflammation, including oxidative stress and insulin resistance, may contribute to endothelial activation and associated worse outcomes among critically ill children. A research agenda to examine this hypothesis is suggested.
Collapse
Affiliation(s)
- Monique Radman
- Seattle Children's Hospital, Pediatric Critical Care, University of Washington, Seattle, WA, United States
| | - John McGuire
- Seattle Children's Hospital, Pediatric Critical Care, University of Washington, Seattle, WA, United States
| | - Jerry Zimmerman
- Seattle Children's Hospital, Pediatric Critical Care, University of Washington, Seattle, WA, United States
| |
Collapse
|
20
|
Kao AM, Arnold MR, Prasad T, Schulman AM. The impact of abnormal BMI on surgical complications after pediatric colorectal surgery. J Pediatr Surg 2019; 54:2300-2304. [PMID: 31104834 DOI: 10.1016/j.jpedsurg.2019.04.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/23/2019] [Accepted: 04/28/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND/PURPOSE While childhood obesity is a growing problem, the implications of BMI on elective pediatric surgery remains poorly described. This study evaluates the impact of obesity on surgical outcomes after elective colorectal procedures. METHODS Children ages 2-18 years undergoing elective colorectal surgery for IBD were identified from the NSQIP-Pediatric database. Patients were classified as underweight (UW), normal weight (NW), overweight (OW) and obese (OB) based on their age- and sex-adjusted BMI. Postoperative complications were compared between cohorts. RESULTS 858 patients (14.8% UW, 64.3% NW, 13.1% OW, 7.8% OB) were identified, with overall complications occurring in 15.3% and SSI in 10.1%. Obese/overweight patients had higher rates of deep incisional SSI (4.5%OB, 4.5%OW, 0%NW, p=0.002) and superficial wound disruption (5.4%OB, 5.8%OW, 1.6%NW, p=0.04). Incremental increase in BMI by 1.0kg/m2 was associated with 4.3% increased likelihood of developing deep incisional SSI and 2.3% increase of superficial wound disruption. Obese/overweight children also had increased incidence of septic shock and UTI, as well as longer operative times, days of mechanical ventilation and LOS. CONCLUSIONS Increasing BMI was associated with increased wound complications in IBD patients undergoing elective intestinal surgery. Preoperative optimization and weight loss strategies may potentially reduce SSI and other infectious complications. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Angela M Kao
- Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd, MEB Suite 601, Charlotte, NC 28203.
| | - Michael R Arnold
- Department of Surgery, Carolinas Medical Center, 1000 Blythe Blvd, MEB Suite 601, Charlotte, NC 28203
| | - Tanushree Prasad
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC 28204
| | - Andrew M Schulman
- Division of Pediatric Surgery, Levine Children's Hospital, 1900 Randolph Rd, #210, Charlotte, NC 28207
| |
Collapse
|
21
|
Campbell RL, Shetty NS, Shetty KS, Pope HL, Campbell JR. Pediatric Dental Surgery Under General Anesthesia: Uncooperative Children. Anesth Prog 2019; 65:225-230. [PMID: 30715931 DOI: 10.2344/anpr-65-03-04] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Dental treatment of young pediatric patients can be confounded by lack of cooperation for dental rehabilitation procedures and even examination and/or radiographs. With the recent US Food and Drug Administration warning applied to many anesthetic/sedative agents for children less than 3 years old, a retrospective review of general anesthesia (GA) cases from 1 private pediatric dental practice was studied for age, gender, body mass index, anesthetic duration, airway management used, extent of dental surgical treatment, recovery time, and cardiac/pulmonary complications. For the 2016 calendar year, 351 consecutive GA cases were identified with patients aged 2-13 years. Of these, 336 underwent nasal endotracheal intubation. Forty-six of 351 patients (13%) were younger than 3 years. Median anesthesia duration was approximately 1.7 hours for all age groups. Dental treatment consisting of 8-9 teeth including crowns, fillings, and extractions was most frequently encountered. One hundred sixty-eight patients (48%), however, required care for 10-18 teeth. There were no episodes of significant oxygen desaturation. The overall complication rate was 1.1%, with 2 cases of postextubation croup, 1 case of mild intraoperative bronchospasm, and 1 case of intraoperative bradycardia. Complications did not correlate with children being overweight or obese.
Collapse
Affiliation(s)
- Robert L Campbell
- Emeritus Professor, Anesthesiology and Oral and Maxillofacial Surgery, Virginia Commonwealth University, Richmond, Virginia
| | - Navin S Shetty
- Private Practice, Pediatric Dentistry, Richmond, Virginia
| | - Kaavya S Shetty
- Anesthesia Research Assistant, Virginia Dental and Anesthesia Associates, Richmond, Virginia
| | - Herbert L Pope
- Private Practice, Pediatric Dentistry, Richmond, Virginia
| | - Jeffrey R Campbell
- Dentist Anesthesiologist, Virginia Dental and Anesthesia Associates, Richmond, Virginia
| |
Collapse
|
22
|
Increased acute postoperative wound problems following spinal fusion in overweight patients with adolescent idiopathic scoliosis. J Pediatr Orthop B 2019; 28:374-379. [PMID: 30768579 DOI: 10.1097/bpb.0000000000000610] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
This study assessed the rate of adverse wound events in individuals with adolescent idiopathic scoliosis who underwent a posterior spinal fusion and sought to determine if obesity was related to the rate of adverse wound events. A retrospective review of patients with adolescent idiopathic scoliosis that underwent posterior spinal fusion between 2001 and 2013 was performed. Preoperative, perioperative, and postoperative data, including wound adverse events, were obtained through medical record review. Using the Center for Disease Control BMI criteria, participants were grouped into overweight/obese (BMI%≥85 percentile) or healthy/underweight (BMI%<85 percentile) groups. Obesity and prolonged hospital stay were independent risk factors for increased risk of wound problems.
Collapse
|
23
|
Raghavan K, Moo DXY, Tan Z. Severe obesity in children as an independent risk factor for perioperative respiratory adverse events during anaesthesia for minor non-airway surgery, a retrospective observational study. PROCEEDINGS OF SINGAPORE HEALTHCARE 2019. [DOI: 10.1177/2010105818802994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: The purpose of this article is to quantify grades of obesity and their independent effects on perioperative adverse events in children having ambulatory minor non-airway surgery. Methods: After obtaining ethics committee approval, we selected every tenth child aged 2 to 16 years who was identified as having been a day case between January 2012 and December 2014. Weight groups were defined based on age- and gender-specific body mass index (BMI) cutoff points. A sample size of 1102 was calculated to demonstrate a three-fold increase in the primary outcome measure, perioperative respiratory-airway adverse events, among obese children, with a power of 80% and an alpha error of 5%. Chi-squared and Fisher exact tests were used to compare proportions, and independent sample t tests were used to compare means. Results: Severely obese children had a significantly higher incidence of perioperative respiratory-airway adverse events when compared to normal-weight children despite no difference in respiratory and other comorbidity. Obese children had higher prevalence of overall medical comorbidities and obstructive sleep apnoea when compared to normal-weight children and there was no significant difference in the incidence of perioperative respiratory-airway adverse events and other outcome measures between obese and normal-weight children. Conclusions and recommendations: Severely obese children have a higher risk of perioperative respiratory-airway adverse events even during minor non-airway surgery despite absence of medical comorbidities. We recommend the use of age- and sex- specific BMI cutoffs or BMI percentile charts to identify children who are severely obese to anticipate and prevent major respiratory adverse events.
Collapse
Affiliation(s)
- Kavitha Raghavan
- Department of Paediatric Anaesthesia, KK Women’s and Children’s Hospital, Singapore
- St. Jude Children’s Research Hospital, USA
| | | | - Zihui Tan
- Singhealth Anaesthesiology Residency Programme, Singapore
| |
Collapse
|
24
|
The Role of Obesity in Pediatric Orthopedics. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2019; 3:e036. [PMID: 31321371 PMCID: PMC6553626 DOI: 10.5435/jaaosglobal-d-19-00036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Pediatric obesity has become a worldwide epidemic and leads to notable effects on the developing skeleton that can have lifelong implications. Obesity in the pediatric population alters bone metabolism, increasing the risk for fracture. It can alter the presentation of common pediatric orthopaedic conditions such as scoliosis. Obesity also leads to changes in the patterns and severity of pediatric fractures as well as alters conservative fracture treatment due to increased displacement risk. Obese pediatric trauma patients place a high burden on the nationwide hospital system in a variety of ways including the increased risk of perioperative complications. Obesity is modifiable, and addressing the issue can improve the orthopaedic and overall health of children.
Collapse
|
25
|
Thalji L, Shi Y, Hanson KT, Wakeam E, Habermann EB, Hyder JA. Characterizing the spectrum of body mass index associated with severe postoperative pulmonary complications in children. J Anesth 2019; 33:372-380. [PMID: 30976907 DOI: 10.1007/s00540-019-02639-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 04/01/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE While high body mass index (BMI) is a recognized risk factor for pulmonary complications in adults, its importance as a risk factor for complications following pediatric surgery is poorly described. We evaluated the association between BMI and severe pediatric perioperative pulmonary complications (PPCs). METHODS In this retrospective cohort study, we evaluated pediatric patients (aged 2-17 years) undergoing elective procedures in the 2015 Pediatric National Surgical Quality Improvement Program (NSQIP-P). Severe PPCs were defined as either pneumonia/reintubation within 3 days of surgery, or pneumonia/reintubation as an index complication within 7 days. Univariate and multivariable logistic regression analyses adjusting for patient factors and surgical case-mix tested associations between BMI class-using the Centers for Disease Control age- and sex-dependent BMI percentiles-and severe PPCs. RESULTS Among 40,949 patients, BMI class was distributed as follows: 2740 (6.7%) were underweight, 23,630 (57.7%) normal weight, 6161 (15.0%) overweight, and 8418 (20.6%) obese. Overweight BMI class was not associated with PPCs in univariate analyses, but became statistically significant after adjustment [OR 1.84 (95% CI 1.07-3.15), p = 0.03], and persisted across multiple adjustment approaches. Neither underweight [OR 1.01 (95% CI 0.53-1.94), p = 0.97] nor obesity [OR 1.10 (95% CI 0.63-1.94), p = 0.73] were associated with PPCs after adjustment. CONCLUSION Overweight pediatric patients have an elevated, previously underappreciated risk of severe PPCs. Contrary to prior studies, the present study found no greater risk in obese children, perhaps due to bias, confounding, or practice migration from "availability bias". Findings from the present study, taken with prior work describing pulmonary risks of obesity, suggest that both obese and overweight children may be evaluated for tailored perioperative care to improve outcomes.
Collapse
Affiliation(s)
- Leanne Thalji
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Yu Shi
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Kristine T Hanson
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
| | - Elliot Wakeam
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Elizabeth B Habermann
- Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
| | - Joseph A Hyder
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Rochester, MN, USA.,Division of Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
26
|
Krajewska Wojciechowska J, Krajewski W, Zatoński T. The Association Between ENT Diseases and Obesity in Pediatric Population: A Systemic Review of Current Knowledge. EAR, NOSE & THROAT JOURNAL 2019; 98:E32-E43. [PMID: 30966807 DOI: 10.1177/0145561319840819] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Obesity in pediatric population is an important global problem. The prevalence of obesity in children is dramatically rising. According to World Health Organization, about 41 million children under the age of 5 years are obese or overweight worldwide. Overweight and obesity are well-known risk factors for a number of health disorders. Diseases commonly observed in this group of patients are metabolic disorders, type 2 diabetes mellitus, cardiovascular diseases, fatty liver disease, musculoskeletal problems, and many others. The main aim of this study was to present the current knowledge of the association between childhood obesity and common otorhinolaryngological disorders. It is suggested that obese children are more prone to suffer from otorhinolaryngological illnesses than the lean ones. Obesity may predispose to otorhinolaryngological diseases in various ways. It strongly interferes with the immune system (increases serum levels of interleukin 6, tumor necrosis factor, C-reactive protein, and leptin and reduces adiponectin concentration) affecting organs of the upper respiratory tract. Additionally, obesity induces mechanical disorders in the upper airways. According to our review, obesity predisposes to otitis media with effusion, acute otitis media, recurrent otitis media, obstructive sleep apnea, sensorineural hearing loss, adenotonsillar hypertrophy, and post-/perioperative complications after adenotonsillectomy. Obesity in children significantly correlates with both obstructive sleep apnea (OSA) and asthma and constitutes a significant component of "OSA, obesity, asthma" triad.
Collapse
Affiliation(s)
| | - Wojciech Krajewski
- 2 Department and Clinic of Urology, Medical University in Wrocław, Wrocław, Poland
| | - Tomasz Zatoński
- 1 Department and Clinic of Otolaryngology, Head and Neck Surgery, Medical University in Wrocław, Wrocław, Poland
| |
Collapse
|
27
|
Abstract
Ambulatory surgery in the pediatric population can be similar to adult ambulatory with a few different challenges. Success is best determined by appropriate preoperative screening. Issues common in pediatrics are the respiratory infection, asthma, congenital heart disease and syndromes, as well as sleep apnea. Risk factors for adverse respiratory events and patient transfer differ from adults as do data for rapid discharge.
Collapse
Affiliation(s)
- Steven F Butz
- Medical College of Wisconsin, Milwaukee, WI, USA; Children's Hospital of Wisconsin Surgicenter, 3223 South 103rd Street, Milwaukee, WI 53227, USA.
| |
Collapse
|
28
|
Perioperative considerations for airway management and drug dosing in obese children. Curr Opin Anaesthesiol 2018; 31:320-326. [PMID: 29697466 DOI: 10.1097/aco.0000000000000600] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE OF REVIEW Childhood obesity, a phenomenon that is increasing globally, holds substantial relevance for pediatric anesthesia. In particular, understanding the nuances of airway management and drug dosing in obese children can be daunting. RECENT FINDINGS Respiratory adverse events and challenges in managing the airway may be anticipated. In addition, drug-dosing strategies for the obese child are complex and poorly understood although recent advances have clarified the optimal dosing for anesthetics in these children. SUMMARY Theoretical knowledge, practical skills, meticulous risk stratification and optimal drug regimens are crucial to ensure the safe conduct of anesthesia for obese children.
Collapse
|
29
|
Lejus C, Orliaguet G, Servin F, Dadure C, Michel F, Brasher C, Dahmani S. Peri-operative management of overweight and obese children and adolescents. THE LANCET CHILD & ADOLESCENT HEALTH 2018; 1:311-322. [PMID: 30169186 DOI: 10.1016/s2352-4642(17)30090-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 07/27/2017] [Accepted: 08/15/2017] [Indexed: 12/11/2022]
Abstract
Obesity has become endemic, even in children. Systemic complications associated with obesity include metabolic syndrome, cardiovascular disease, and respiratory compromise. These comorbidities require adequate investigation, targeted optimisation, and, if surgery is required, specific management during the peri-operative period. Specific peri-operative strategies should be used for paediatric patients who are overweight or obese to prevent postoperative complications, and optimising the respiratory function during surgery is particularly crucial. This Review aims to provide up-to-date information on peri-operative management for physicians who are caring for children and adolescents (usually younger than 18 years) who are overweight or obese undergoing surgery, including bariatric surgery. We have particularly focussed on the physiological consequences of obesity-namely, obstructive sleep apnoea, respiratory compromise, and pharmacological considerations.
Collapse
Affiliation(s)
- Corinne Lejus
- Department of Anaesthesia and Intensive care, Hôtel Dieu Hospital, Nantes, France
| | - Gilles Orliaguet
- Department of Anaesthesia and Intensive Care, Assistance Publique Hôpitaux de Paris, Necker-Enfants Malades Hospital, Paris, France; EA08 Pharmacologie et évaluation des thérapeutiques chez l'enfant et la femme enceinte, Paris-Descartes and Paris Descartes University (Paris V), PRES Paris Sorbonne Cité, Paris, France
| | - Frederique Servin
- Department of Anaesthesia and Intensive Care, Assistance Publique Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Christophe Dadure
- Department of Anaesthesia and Intensive care, Lapeyronie University Hospital, Montpellier, France; Institut de Neuroscience de Montpellier, Unité INSERM, Montpellier, France
| | - Fabrice Michel
- Department of Anaesthesia and Intensive Care, La Timone Hospital, Marseille, France; Espace Ethique Méditerranéen, Aix-Marseille Université, Hôpital Timone Adulte, Marseille, France
| | - Christopher Brasher
- Department of Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, VIC, Australia; Anesthesia and Pain Management Research Group, Murdoch Children's Research Institute, VIC, Australia
| | - Souhayl Dahmani
- DHU PROTECT, INSERM U1141, Paris, France; Department of Anaesthesia and Intensive Care, Robert Debré University Hospital, Assistance Publique Hôpitaux de Paris, Paris Diderot University, PRES Paris Sorbonne Cité, Paris, France.
| |
Collapse
|
30
|
Accuracy of identifying the cricothyroid membrane in children using palpation. J Anesth 2018; 32:768-773. [DOI: 10.1007/s00540-018-2538-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/24/2018] [Indexed: 12/19/2022]
|
31
|
Chidambaran V, Tewari A, Mahmoud M. Anesthetic and pharmacologic considerations in perioperative care of obese children. J Clin Anesth 2018; 45:39-50. [DOI: 10.1016/j.jclinane.2017.12.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 12/11/2017] [Accepted: 12/14/2017] [Indexed: 10/18/2022]
|
32
|
Nafiu OO, Chimbira WT, Tait AR. Pediatric Preoperative Assessment: Six Million Missed Opportunities for Childhood Obesity Education. Anesth Analg 2018; 126:343-345. [PMID: 28452815 DOI: 10.1213/ane.0000000000001990] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Olubukola O Nafiu
- From the Department of Anesthesiology, Section of Pediatric Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | | | | |
Collapse
|
33
|
Rogerson CM, Abulebda K, Hobson MJ. Association of BMI With Propofol Dosing and Adverse Events in Children With Cancer Undergoing Procedural Sedation. Hosp Pediatr 2017; 7:542-546. [PMID: 28798230 DOI: 10.1542/hpeds.2016-0191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Obesity increases the risk of complications during pediatric procedural sedation. The risk of being underweight has not been evaluated in this arena. We therefore investigated the association of BMI with sedation dosing and adverse events in children across a range of BMIs. METHODS A total of 1976 patients ages 2 to 21 years old with oncologic diagnoses underwent lumbar punctures and/or bone marrow aspirations. All children received a standard adjunctive dose of ketamine before sedation with propofol. Weight categories were stratified by BMI percentile: underweight <5%, normal weight 5% to 85%, overweight >85%, and obese >95%. Dosing and adverse events (hypoxia, apnea, bradycardia, or hypotension) were reviewed. RESULTS There were no differences in propofol dosing for procedural sedation between patients who were normal weight and underweight. However, children who were overweight and those who were obese used less propofol compared with children who were normal weight (P < .01). Children who were underweight had a higher proportion of adverse events overall relative to those children of normal weight (P < .001). In contrast, there was not an increase in adverse events for patients who were overweight and obese. CONCLUSIONS Children who are overweight and children with obesity who require deep sedation can undergo successful sedation with lower propofol dosing relative to children of a normal weight. This dosing strategy may help to mitigate the risks associated with sedating patients who are obese. Notably, children who were underweight had an increased rate of complications despite receiving an equal amount of sedation compared with patients who were normal weight. This should alert the clinicians to the risks associated with sedating children who are underweight.
Collapse
Affiliation(s)
- Colin M Rogerson
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana; and
| | - Kamal Abulebda
- Division of Pediatric Critical Care Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - Michael J Hobson
- Division of Pediatric Critical Care Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| |
Collapse
|
34
|
Pilot study comparing post-anesthesia care unit length of stay in moderately and severely obese children. J Anesth 2017; 31:510-516. [PMID: 28243748 DOI: 10.1007/s00540-017-2326-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 02/09/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Obesity is a risk factor for surgical complications in adults and children. Differences in postsurgical outcomes according to severity of obesity [moderate: 95-98th age-gender-specific body mass index (BMI) percentile versus severe: ≥99th percentile] in children remain unclear. This study compared post-anesthesia care unit (PACU) stay and hospital admission between severely obese children and moderately obese children undergoing surgery. METHODS In a retrospective review over a 6-month period, obese children, 2-18 years of age undergoing surgery were identified. Multivariate mixed-effects regression was used to compare PACU length of stay (LOS) need for opioid analgesia, and hospital admission between moderately and severely obese patients. RESULTS There were 1324 records selected for inclusion. PACU LOS did not significantly differ between moderately obese (50 ± 36 min) and severely obese patients (55 ± 38 min). There were no differences between moderately and severely obese patients in use of opioids in the PACU. Yet, severely obese patients were more likely to require inpatient admission than moderately obese patients. CONCLUSIONS The duration of PACU stay still averaged less than 1 h in our cohort, suggesting that the majority of these patients can be cared for safely in the outpatient setting. Future studies should focus on identifying the co-morbid conditions that may prolong postoperative PACU stay or result in unplanned hospital admission in moderately and severely obese patients. Our preliminary data suggest that these factors may include a younger age and the complexity or duration of the surgical procedure.
Collapse
|
35
|
Hirsch DG, Tyo J, Wrotniak BH. Desaturation in procedural sedation for children with long bone fractures: Does weight status matter? Am J Emerg Med 2017; 35:1060-1063. [PMID: 28245939 DOI: 10.1016/j.ajem.2017.02.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 02/14/2017] [Accepted: 02/17/2017] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Childhood obesity remains a serious problem in the United States. Significant associated adverse incidents have been reported with sedation of children with obesity, namely hypoxemia. The objective of our study was to determine if overweight and obesity were associated with increased desaturations during procedural sedation compared with patients of healthy weight. METHODS This was a single-center retrospective chart review of data from a three-year period of patient's age 2-17years. Of the 1700 charts reviewed 823 of these patients received procedural sedation and met the study inclusion criteria. Weight status was classified based on age and gender specific body mass index (BMI) percentiles: underweight, healthy weight, overweight, obese. RESULTS Among all weight categories there was no statistical significance, however children with obesity had greater desaturation rates (9.9%) compared with children of underweight, healthy weight, or overweight combined (5.4%), χ2=4.46, p=0.035. DISCUSSION The results indicate that children with obesity are almost twice as likely to have a desaturation related to procedural sedation compared with children of other weight status. Providers should be aware that children with obesity may be more likely to desaturate than other children, and therefore be skilled at recognizing this.
Collapse
Affiliation(s)
- Danielle G Hirsch
- Women and Children's Hospital of Buffalo, University Pediatric Associates, Division of Pediatric Emergency Medicine, 219 Bryant Street, Buffalo, NY 14222, USA; Women and Children's Hospital of Buffalo, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, 3435 Main Street, Buffalo, NY 14214, USA.
| | - John Tyo
- Women and Children's Hospital of Buffalo, University Pediatric Associates, Division of Pediatric Emergency Medicine, 219 Bryant Street, Buffalo, NY 14222, USA; Women and Children's Hospital of Buffalo, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, 3435 Main Street, Buffalo, NY 14214, USA
| | - Brian H Wrotniak
- Women and Children's Hospital of Buffalo, University Pediatric Associates, Division of Pediatric Emergency Medicine, 219 Bryant Street, Buffalo, NY 14222, USA; Women and Children's Hospital of Buffalo, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, 3435 Main Street, Buffalo, NY 14214, USA
| |
Collapse
|
36
|
Ulrici J, Hempel G, Sasse M, Vollrath J, Höhne C. Atemwegskomplikationen bei übergewichtigen und adipösen Kindern. Anaesthesist 2016; 65:911-916. [DOI: 10.1007/s00101-016-0229-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 09/02/2016] [Accepted: 09/06/2016] [Indexed: 11/24/2022]
|
37
|
Suboptimal Clinical Documentation in Young Children with Severe Obesity at Tertiary Care Centers. Int J Pediatr 2016; 2016:4068582. [PMID: 27698673 PMCID: PMC5028875 DOI: 10.1155/2016/4068582] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 08/04/2016] [Accepted: 08/08/2016] [Indexed: 12/13/2022] Open
Abstract
Background and Objectives. The prevalence of severe obesity in children has doubled in the past decade. The objective of this study is to identify the clinical documentation of obesity in young children with a BMI ≥ 99th percentile at two large tertiary care pediatric hospitals. Methods. We used a standardized algorithm utilizing data from electronic health records to identify children with severe early onset obesity (BMI ≥ 99th percentile at age <6 years). We extracted descriptive terms and ICD-9 codes to evaluate documentation of obesity at Boston Children's Hospital and Cincinnati Children's Hospital and Medical Center between 2007 and 2014. Results. A total of 9887 visit records of 2588 children with severe early onset obesity were identified. Based on predefined criteria for documentation of obesity, 21.5% of children (13.5% of visits) had positive documentation, which varied by institution. Documentation in children first seen under 2 years of age was lower than in older children (15% versus 26%). Documentation was significantly higher in girls (29% versus 17%, p < 0.001), African American children (27% versus 19% in whites, p < 0.001), and the obesity focused specialty clinics (70% versus 15% in primary care and 9% in other subspecialty clinics, p < 0.001). Conclusions. There is significant opportunity for improvement in documentation of obesity in young children, even years after the 2007 AAP guidelines for management of obesity.
Collapse
|
38
|
Abstract
INTRODUCTION Children with Legg-Calvé-Perthes disease classically have been described as thin, small, and socioeconomically disadvantaged. Despite the obesity epidemic, no study has determined the prevalence of obesity in this patient population and its effect on treatment. METHODS This is a retrospective study of 150 patients (172 hips) with Legg-Calvé-Perthes disease seen between 2009 and 2014. Patients were grouped based on body mass index at the initial visit. This cohort was analyzed on the basis of the treatment received and socioeconomic status. RESULTS Of 150 patients with Legg-Calvé-Perthes disease, 16% were overweight and 32% were obese. Patients who were obese had a 2.8 lower likelihood of receiving a bony operation (confidence interval: 1.1 to 7.7). Obesity in patients with the disease was associated with later Waldenström stage at presentation (P = 0.003), lower median household income by zip code (P < 0.001), and greater use of government-funded health insurance (P < 0.001). DISCUSSION Obesity is common in patients with Legg-Calvé-Perthes disease and is associated with a later stage of disease presentation. LEVEL OF EVIDENCE Level III.
Collapse
|
39
|
Jauregui JJ, Elmallah RK, Harwin SF, Pierce TP, Cherian JJ, Naziri Q, Mont MA. Characteristics and Complications of Super-Obese Patients Who Underwent Total Knee Arthroplasty. Orthopedics 2016; 39:e800-5. [PMID: 27203414 DOI: 10.3928/01477447-20160513-05] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 06/26/2015] [Indexed: 02/03/2023]
Abstract
Preoperative demographic characteristics, comorbidities, length of stay and surgery, and postoperative complications were compared between super-obese (n=1042) and nonobese (n=19,929) patients who underwent total knee arthroplasty. Super-obese patients were younger, were predominantly women, had an increased incidence of comorbid conditions such as diabetes and hypertension as well as a high rate of superficial and deep wound infections, and had a longer mean length of stay and operative time. Although super-obese patients have unique demographic characteristics and increased postoperative complications and length of stay, they may still benefit from total knee arthroplasty. Surgeons should note their high incidence of infections. [Orthopedics. 2016; 39(4):e800-e805.].
Collapse
|
40
|
Anesthetic considerations for pediatric obesity and adolescent bariatric surgery. Curr Opin Anaesthesiol 2016; 29:327-36. [DOI: 10.1097/aco.0000000000000330] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
41
|
Kiekkas P, Stefanopoulos N, Bakalis N, Kefaliakos A, Konstantinou E. Perioperative Adverse Respiratory Events in Overweight/Obese Children: Systematic Review. J Perianesth Nurs 2016; 31:11-22. [DOI: 10.1016/j.jopan.2014.11.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 11/06/2014] [Accepted: 11/22/2014] [Indexed: 10/22/2022]
|
42
|
Canada NL, Mullins L, Pearo B, Spoede E. Optimizing Perioperative Nutrition in Pediatric Populations. Nutr Clin Pract 2015; 31:49-58. [DOI: 10.1177/0884533615622639] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Nicki L. Canada
- Department of Food and Nutrition Services, Texas Children’s Hospital, Houston, Texas, USA
| | - Lucille Mullins
- Department of Food and Nutrition Services, Texas Children’s Hospital, Houston, Texas, USA
| | - Brittany Pearo
- Department of Food and Nutrition Services, Texas Children’s Hospital, Houston, Texas, USA
| | - Elizabeth Spoede
- Department of Food and Nutrition Services, Texas Children’s Hospital, Houston, Texas, USA
| |
Collapse
|
43
|
Lavin JM, Shah RK. Postoperative complications in obese children undergoing adenotonsillectomy. Int J Pediatr Otorhinolaryngol 2015; 79:1732-5. [PMID: 26265405 DOI: 10.1016/j.ijporl.2015.07.038] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/25/2015] [Accepted: 07/27/2015] [Indexed: 10/23/2022]
Abstract
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.
Collapse
Affiliation(s)
- Jennifer M Lavin
- Division of Otolaryngology, Children's National Medical Center, Washington, DC, United States; Department of Otolaryngology - Head and Neck Surgery, George Washington University School of Medicine, Washington, DC, United States
| | - Rahul K Shah
- Division of Otolaryngology, Children's National Medical Center, Washington, DC, United States; Department of Otolaryngology - Head and Neck Surgery, George Washington University School of Medicine, Washington, DC, United States.
| |
Collapse
|
44
|
Abstract
High levels of dental caries, challenging child behavior, and parent expectations support a need for sedation in pediatric dentistry. This paper reviews modern developments in pediatric sedation with a focus on implementing techniques to enhance success and patient safety. In recent years, sedation for dental procedures has been implicated in a disproportionate number of cases that resulted in death or permanent neurologic damage. The youngest children and those with more complicated medical backgrounds appear to be at greatest risk. To reduce complications, practitioners and regulatory bodies have supported a renewed focus on health care quality and safety. Implementation of high fidelity simulation training and improvements in patient monitoring, including end-tidal carbon dioxide, are becoming recognized as a new standard for sedated patients in dental offices and health care facilities. Safe and appropriate case selection and appropriate dosing for overweight children is also paramount. Oral sedation has been the mainstay of pediatric dental sedation; however, today practitioners are administering modern drugs in new ways with high levels of success. Employing contemporary transmucosal administration devices increases patient acceptance and sedation predictability. While recently there have been many positive developments in sedation technology, it is now thought that medications used in sedation and anesthesia may have adverse effects on the developing brain. The evidence for this is not definitive, but we suggest that practitioners recognize this developing area and counsel patients accordingly. Finally, there is a clear trend of increased use of ambulatory anesthesia services for pediatric dentistry. Today, parents and practitioners have become accustomed to children receiving general anesthesia in the outpatient setting. As a result of these changes, it is possible that dental providers will abandon the practice of personally administering large amounts of sedation to patients, and focus instead on careful case selection for lighter in-office sedation techniques.
Collapse
Affiliation(s)
- Travis M Nelson
- Department of Pediatric Dentistry, University of Washington, Seattle, WA, USA
| | - Zheng Xu
- Department of Pediatric Dentistry, University of Washington, Seattle, WA, USA
| |
Collapse
|
45
|
Scherrer PD, Mallory MD, Cravero JP, Lowrie L, Hertzog JH, Berkenbosch JW. The impact of obesity on pediatric procedural sedation-related outcomes: results from the Pediatric Sedation Research Consortium. Paediatr Anaesth 2015; 25:689-97. [PMID: 25817924 DOI: 10.1111/pan.12627] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/01/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the impact of obesity on adverse events and required interventions during pediatric procedural sedation. METHODS The Pediatric Sedation Research Consortium database of prospectively collected procedural sedation encounters was queried to identify patients for whom body mass index (BMI) could be calculated. Obesity was defined as BMI ≥95th percentile for age and gender. Sedation-related outcomes, adverse events, and therapeutic interventions were compared between obese and nonobese patients. RESULTS For analysis, 28,792 records were eligible. A total of 5,153 patients (17.9%) were obese; they were predominantly male and older and had a higher median American Society of Anesthesiologists Physical Status classification (P < 0.001). Total adverse events were more common in obese patients (odds ratio [OR] 1.49, 95% confidence interval [1.31, 1.70]). Respiratory events (airway obstruction OR 1.94 [1.54, 2.44], oxygen desaturation OR 1.99 [1.50, 2.63], secretions OR 1.48 [1.01, 2.15], laryngospasm OR 2.30 [1.30, 4.05]), inability to complete the associated procedure (OR 1.96 [1.16, 3.30]), and prolonged recovery (OR 2.66 [1.26, 5.59]) were increased in obese patients. Obese patients more frequently required airway intervention including repositioning, suctioning, jaw thrust, airway adjuncts, and bag-valve-mask ventilation. Multivariate regression analysis demonstrated obesity to be independently associated with minor and moderate but not major adverse events. CONCLUSIONS Obesity is an independent risk factor for adverse respiratory events during procedural sedation and is associated with an increased frequency of airway interventions, suggesting that additional vigilance and expertise are required when sedating these patients.
Collapse
Affiliation(s)
- Patricia D Scherrer
- Children's Respiratory and Critical Care Specialists, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - Michael D Mallory
- Pediatric Emergency Medicine Associates, Children's Healthcare of Atlanta at Scottish Rite Hospital, Atlanta, GA, USA
| | - Joseph P Cravero
- Department of Anesthesiology, Boston Children's Hospital, Boston, MA, USA
| | - Lia Lowrie
- Department of Pediatrics, St Louis University at Cardinal Glennon Children's Hospital, St Louis, MO, USA
| | - James H Hertzog
- Department of Anesthesiology and Critical Care Medicine, Alfred I duPont Hospital for Children, Wilmington, DE, USA
| | - John W Berkenbosch
- Division of Pediatric Critical Care, Department of Pediatrics, University of Louisville, Louisville, KY, USA
| | | |
Collapse
|
46
|
Kline-Tilford AM. Impact of Obesity during Pediatric Acute and Critical Illness. J Pediatr Intensive Care 2015; 4:97-102. [PMID: 31110858 PMCID: PMC6513140 DOI: 10.1055/s-0035-1556752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 12/13/2014] [Indexed: 10/23/2022] Open
Abstract
Pediatric overweight and obesity rates have reached epidemic proportions and continue to rise globally. Many long-term complications have been described about the impact of obesity; however, little work has been done in the area of acute and critical illness in children. Available evidence suggests that childhood obesity can impact acute and critical illness when compared with normal weight cohorts. This review will discuss the available literature on the impact of pediatric obesity during acute and critical illness.
Collapse
Affiliation(s)
- Andrea M. Kline-Tilford
- Department of Cardiovascular Surgery, Children's Hospital of Michigan, Detroit, Michigan, United States
| |
Collapse
|
47
|
Abstract
BACKGROUND Obese patients are highly prevalent in the pediatric orthopaedic surgeon's practice and obesity is an increasing issue in the United States. Increased body mass index (BMI) has been associated with increased complications in pediatric orthopaedic patients, but no study has looked specifically at external fixation. The purpose of this study was to determine whether obesity is a risk factor for increased complications in lower-extremity procedures requiring external fixation. METHODS A retrospective chart review was conducted of pediatric patients who underwent external fixation as definitive operative treatment for any condition at a tertiary care hospital over a 15-year period. Patients were grouped into normal weight, overweight, and obese based on Centers for Disease Control definitions. All orthopaedic complications were recorded. RESULTS A total of 208 patients with a mean age of 11.2 years were identified. Ninety-four children were obese at the 95th percentile BMI or higher, 22 were overweight and 93 were normal weight. External fixation was applied to the tibia in 82 cases, to the femur in 77 and to both in 49. Mean duration of fixation was 160 days (range, 31 to 570 d) and patients were followed for a mean of 3.9 years (range, 1.0 to 12.0 y). There was no statistically significant difference in the rate of complications between the 3 groups (P=0.61). In the obese group complications occurred in 68.1% versus 66.7% in the overweight group and 61.3% in normal weight. CONCLUSIONS In the setting of external fixator use for lower-extremity pathology in pediatric patients, there is no association between an increase in complications and obesity as defined by BMI. Complication rates are high when external fixation is utilized for the lower extremity, however, patients and families should not be counseled that increased BMI will add to the burden of orthopaedic complications in this situation. LEVEL OF EVIDENCE Level II-prognostic.
Collapse
|
48
|
Nafiu OO, Onyewuche V. Association of abdominal obesity in children with perioperative respiratory adverse events. J Perianesth Nurs 2015; 29:84-93. [PMID: 24661478 DOI: 10.1016/j.jopan.2013.03.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 01/01/2013] [Accepted: 03/08/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND/PURPOSE Waist circumference (WC), a measure of abdominal obesity, is associated with several chronic disorders. Less is known about the association between WC and acute perioperative adverse events. The purpose of the present investigation was to test the hypothesis that abdominal obesity increases the occurrence of perioperative adverse events in children undergoing elective, noncardiac surgeries. DESIGN Prospective observational study. METHODS We studied the association between WC and perioperative adverse events in children aged 6 to 18 years who underwent elective noncardiac surgeries at our institution. Patients were considered to have abdominal obesity if WC was 90th percentile or greater for age and gender. Subsequently, univariate factors associated with abdominal obesity were explored and then odds ratios for the occurrence of perioperative respiratory adverse events were calculated from logistic regression after controlling for clinically pertinent covariates. RESULTS Among 1,102 patients, the prevalence of abdominal obesity was 23.1%. WC was positively correlated with age and measured anthropometric parameters. Composite perioperative adverse events were more frequent in children with abdominal obesity. After adjusting for several clinically relevant risk factors, abdominal obesity independently predicted increased relative odds of respiratory adverse events (OR = 2.35, 95% CI = 1.6 to 3.5, P < .001). Abdominal obesity was also associated with prolonged postanesthesia care unit (PACU) length of stay. CONCLUSION WC, a measure of abdominal obesity, is an independent predictor of perioperative respiratory adverse events in children undergoing elective noncardiac surgery. Furthermore, abdominal obesity was associated with prolonged PACU length of stay.
Collapse
|
49
|
Lee JJ, Sun LS, Gu B, Kim M, Wang S, Han S. Does obesity prolong anesthesia in children undergoing common ENT surgery? Paediatr Anaesth 2014; 24:1037-43. [PMID: 24824287 DOI: 10.1111/pan.12442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2014] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To report the epidemiology of obesity in a pediatric surgical population and determine whether obesity is a risk factor for longer anesthesia duration. BACKGROUND Childhood obesity is a significant public health problem in the United States. Epidemiologic studies on pediatric surgical populations have been limited to states with very high prevalence of adult obesity (Michigan, Texas). Data from other states and more recent data since 2006 are unavailable. METHODS We examined anesthesia records for surgical patients age 2-18 years at Columbia University Medical Center from January 2009 to December 2010. Patients undergoing bariatric surgery or those with records missing preoperative height or weight data were excluded. Body mass index (BMI) was calculated as weight (kg)/height (m(2) ). BMI ≥95th percentile according to national growth charts were considered obese. RESULTS We reviewed 9522 patients of which 1639 were obese (17.2%). The sex-age category interaction on obesity was not significant using logistic regression (P = 0.11). Among surgical groups, the otolaryngology (ENT) cohort had the highest obesity rate (21.7%, 360/1656). Obese children who had tonsillectomy, adenoidectomy, or both did not have a prolonged anesthetic (P = 0.33) or surgical duration (P = 0.61) compared with nonobese children, adjusting for surgeon, season, surgical procedure code, and ASA status. CONCLUSION Children presenting for surgery, particularly the ENT cohort, have a high prevalence of obesity. Obese and nonobese children who had tonsillectomy, adenoidectomy, or both had comparable durations of anesthesia. Therefore, obesity did not lead to longer anesthetic duration.
Collapse
Affiliation(s)
- Jennifer J Lee
- Department of Anesthesiology, Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | |
Collapse
|
50
|
Halvorson EE, Irby MB, Skelton JA. Pediatric obesity and safety in inpatient settings: a systematic literature review. Clin Pediatr (Phila) 2014; 53:975-87. [PMID: 24803638 DOI: 10.1177/0009922814533406] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Pediatric obesity affects more than 16% of American children and is associated with worse outcomes in hospitalized patients. A systematic literature review was performed to identify studies of adverse care events affecting obese pediatric patients in the emergency room, operating room, or inpatient wards. EVIDENCE REVIEW We systematically searched Medline for articles published from 1970 to 2013 regarding obesity and patient safety events in pediatric acute care settings. We determined the study design, number of patients studied, definition and prevalence of obesity, the relevant acute care setting, the specific association with obesity addressed, and the results of each study. RESULTS AND CONCLUSION Thirty-four studies documented both procedural complications and issues with general hospital care. Most were retrospective and focused on surgery or anesthesia. Obese patients may have increased risk for a variety of adverse events. Further study could improve institutional patient safety guidelines to enhance care for obese children.
Collapse
Affiliation(s)
| | - Megan B Irby
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA Brenner FIT Program, Brenner Children's Hospital, Winston-Salem, NC, USA
| | - Joseph A Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA Brenner FIT Program, Brenner Children's Hospital, Winston-Salem, NC, USA Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|