Department of Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA.
Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA.
Otolaryngol Head Neck Surg. 2024 Jan;170(1):277-283. doi: 10.1002/ohn.512. Epub 2023 Sep 5.
To analyze the growth trajectory of children with obesity before and after adenotonsillectomy (T&A). We hypothesize that T&A will not affect the growth trajectory but children in a multidisciplinary weight management program (MWMP) will have a healthier growth trajectory.
Retrospective review.
Tertiary Children's Hospital.
Body mass index (BMI) trajectories of nonsyndromic children with obesity and obstructive sleep apnea (OSA) who underwent T&A were analyzed. A linear mixed effects model was fit to the BMI expressed as a percentage of the 95th percentile (%BMI ) data. Covariates included demographic variables, pre- and postoperative participation in an MWMP, baseline obesity class, and time. We explored clinically meaningful interactions. BMI slope estimates before and after surgery were calculated and compared for baseline obesity classification and postoperative MWMP visits.
A total of 177 patients, 58% male with a mean age of 9.7 years at the time of surgery, were studied. Higher baseline obesity class (II and III), time, the interaction between obesity class III and elapsed time relative to surgical date, and the interaction between obesity class III and the postsurgical period were all significantly associated with the outcome of %BMI (P < .05). There was a significantly higher %BMI trajectory following surgery in patients with baseline obesity class III who did not have any postoperative MWMP visits (P < .001). Preoperative obesity visits, however, were not significantly associated with postoperative growth.
The association between T&A and weight trajectory depends upon obesity class and participation in a MWMP. Coordinated care of children with obesity between otolaryngologists and an MWMP may improve OSA and obesity outcomes.
The level of evidence: 3.
分析肥胖儿童腺样体扁桃体切除术（T&A）前后的生长轨迹。我们假设 T&A 不会影响生长轨迹，但接受多学科体重管理计划（MWMP）的儿童会有更健康的生长轨迹。
回顾性研究。
三级儿童医院。
分析了患有肥胖症和阻塞性睡眠呼吸暂停（OSA）的非综合征儿童接受 T&A 前后的体重指数（BMI）轨迹。对 BMI 以第 95 百分位（%BMI）的形式表示的数据进行线性混合效应模型拟合。协变量包括人口统计学变量、术前和术后是否参加 MWMP、基线肥胖等级和时间。我们探索了有临床意义的相互作用。计算了手术前后 BMI 斜率估计值，并根据基线肥胖分类和术后 MWMP 就诊情况进行了比较。
共研究了 177 名患者，58%为男性，手术时的平均年龄为 9.7 岁。较高的基线肥胖等级（II 和 III）、时间、肥胖等级 III 与手术日期之间的时间和肥胖等级 III 与术后期间的相互作用均与 %BMI 的结果显著相关（P<.05）。在基线肥胖等级为 III 且没有任何术后 MWMP 就诊的患者中，术后 %BMI 轨迹明显更高（P<.001）。然而，术前肥胖就诊与术后生长无显著相关性。
T&A 与体重轨迹之间的关系取决于肥胖等级和是否参加 MWMP。耳鼻喉科医生与 MWMP 共同为肥胖儿童提供协调护理可能会改善 OSA 和肥胖的结局。
3 级。
