- Design
- Systematic review and random-effects meta-analysis
- Population
- 18 studies, 60,044 children having tonsillectomy
- Primary outcome
- Postoperative respiratory complications
- Effect
- 12.2% vs 7.6%; OR 1.86 (95% CI 1.38–2.49), I² 77.5%; no excess in ward-only studies
This systematic review and meta-analysis, published in Otolaryngology–Head and Neck Surgery on 29 September, pooled 18 studies of 60,044 children having tonsillectomy, 7.8% of whom had obesity. Mean ages ranged from 4 to 9 years.
Respiratory complications occurred in 12.2% of children with obesity and 7.6% without, nearly double the odds (OR 1.86), with high heterogeneity. The excess appeared only in studies that counted events in the recovery room. In studies limited to events on the ward, obesity did not increase the odds.
Many units admit every child with obesity overnight after tonsillectomy. These data suggest the risk shows itself early: a child with obesity who recovers without respiratory events in the recovery room may be at no greater ward risk than other children. Guidelines have not changed, and children with severe sleep apnoea or other comorbidities still need individual decisions.
- Observe children with obesity closely in the recovery room after tonsillectomy.
- Use events in recovery, not obesity alone, to decide on overnight admission.
- Keep planned admission for severe sleep apnoea, young age or significant comorbidity.
- Consider same-day discharge for children with obesity who recover without events, where local policy allows.
- Audit recovery-room respiratory events to inform your unit's discharge criteria.
Why it matters
Automatic overnight admission for every child with obesity may not be needed for those who recover well.
Don't overread it
The subgroup finding is observational and the studies varied widely; local guidelines have not changed.
The statistics, in plain English
An odds ratio of 1.86 means nearly twice the odds of a respiratory complication. An I² of 77.5% shows the studies disagreed a lot, and the ward-only result comes from a subgroup, which is weaker evidence than the main estimate.
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