Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon.
Departments of Orthopedic Surgery.
J Pediatr Orthop. 2020 Nov/Dec;40(10):604-607. doi: 10.1097/BPO.0000000000001591.
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.
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.
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).
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 III-case-control study.
肥胖与 Blount 病和阻塞性睡眠呼吸暂停（OSA）都密切相关。肥胖增加了麻醉和术后并发症的风险，而 OSA 可以进一步加剧这些风险。由于患有 Blount 病的儿童可能同时患有这两种疾病，我们试图确定这些儿童的围手术期并发症和 OSA 的患病率。
从以下两个来源确定接受 Blount 病矫正手术的 18 岁以下患者：单一机构的回顾性记录审查和全国代表性数据库 Kids' Inpatient Database 的查询。
在我们的机构中，接受手术治疗的 Blount 病患者中 OSA 的患病率为 23%（42/184）。Blount 患者肥胖（100%），主要是非洲裔美国人（89%），男性（68%）。患者在手术前接受了 OSA 的治疗，有 2 名患者（1%）出现术后低氧血症。相比之下，在 Kids' Inpatient Database 中的 1059 例 Blount 病病例中，有 3%被诊断为 OSA。总的来说，所有 Blount 病患儿中有 4.4%经历了并发症，包括低氧血症、呼吸功能不全、肺不张和心律失常。并发症导致住院时间增加 4.3 天（P<0.0001）和住院费用增加 39%（P=0.002）。
来自国家数据库的数据显示 OSA 患病率较低，但呼吸和 OSA 相关并发症较高，这可能表明 Blount 病患儿中的 OSA 可能被漏诊。受影响的患者，特别是未经治疗的 OSA 患者，承受着更高的手术发病率。高度怀疑和术前计划有助于减轻这些患者的 OSA 负担。
三级病例对照研究。
