Breathing Institute, Children's Hospital Colorado, Aurora, Colorado, U.S.A.
Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A.
Laryngoscope. 2022 Feb;132(2):461-469. doi: 10.1002/lary.29712. Epub 2021 Jun 30.
OBJECTIVES/HYPOTHESIS: To determine the success of an adenotonsillectomy (T&A) in treating children with severe obesity utilizing a more accurate obesity scale.
Retrospective cohort.
A retrospective cohort of children with obesity between 5 and 10 years of age who underwent a T&A at Children's Hospital of Colorado (CHCO) was used. This study also utilized publicly available data from the Childhood Adenotonsillectomy Trial (CHAT) study. The cohort was divided into three obesity classes using age- and sex-specific body mass index (BMI) expressed as a percentage of the 95th percentile (%BMIp95) and compared for operative success differences.
There were 132 patients included in our primary analysis, with obesity distribution as follows: Class 1 to 53 patients (40%), Class 2 to 45 patients (34%), and Class 3 to 34 patients (26%). Overall, 52 patients (35.9%) experienced a cure (obstructive apnea/hypopnea index [OAHI] <1), with 27 (52%) patients in Class 1 obesity, 18 (35%) in Class 2, and 7 (13%) in Class 3. Class 3 had a significantly lower obstructive sleep apnea cure rate compared with Class 1 patients (P = .013), but after adjusting for covariates, this difference was no longer present (P > .05). There was no significant difference in the preoperative to postoperative percent change in mean oxygen saturation (P = .82 CHCO, P = .43 CHAT), oxygen nadir (P = .20 CHCO, P = .49 CHAT), or OAHI (P = .12 CHCO, P = .26 CHAT) between the obesity classes.
After adjusting for covariates, children with Class 3 obesity are as likely to be cured with a T&A as those with Class 1 obesity. A T&A should be considered a first line treatment for all children with obesity.
3 Laryngoscope, 132:461-469, 2022.
目的/假设：利用更准确的肥胖量表来确定腺样体切除术（T&A）治疗重度肥胖儿童的成功率。
回顾性队列研究。
使用科罗拉多儿童医院（CHCO）接受 T&A 的 5 至 10 岁肥胖儿童的回顾性队列。本研究还利用了 Childhood Adenotonsillectomy Trial（CHAT）研究中公开可用的数据。该队列根据年龄和性别特异性体重指数（BMI）分为三个肥胖类别，以 95 百分位（%BMIp95）的百分比表示，并比较手术成功率的差异。
我们的主要分析包括 132 名患者，肥胖分布如下：第 1 类至第 53 名患者（40%），第 2 类至第 45 名患者（34%），第 3 类至第 34 名患者（26%）。总体而言，52 名患者（35.9%）治愈（阻塞性呼吸暂停/低通气指数[OAHI] <1），第 1 类肥胖患者 27 名（52%），第 2 类肥胖患者 18 名（35%），第 3 类肥胖患者 7 名（13%）。第 3 类肥胖患者的阻塞性睡眠呼吸暂停治愈率明显低于第 1 类肥胖患者（P=.013），但调整协变量后，这种差异不再存在（P>.05）。肥胖类别之间，术前到术后平均血氧饱和度的百分比变化（P=.82 CHCO，P=.43 CHAT）、血氧饱和度最低点（P=.20 CHCO，P=.49 CHAT）或 OAHI（P=.12 CHCO，P=.26 CHAT）均无显著差异。
调整协变量后，第 3 类肥胖儿童与第 1 类肥胖儿童一样有可能通过 T&A 治愈。T&A 应被视为所有肥胖儿童的一线治疗方法。
3 级喉镜检查，132：461-469，2022 年。
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