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Original Investigation |

Analysis of Growth Curves in Children After Adenotonsillectomy

Josephine A. Czechowicz, MD1; Kay W. Chang, MD1
[+] Author Affiliations
1Department of Otolaryngology–Head and Neck Surgery, Lucille Packard Children’s Hospital, Stanford University School of Medicine, Stanford, California
JAMA Otolaryngol Head Neck Surg. 2014;140(6):491-496. doi:10.1001/jamaoto.2014.411.
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Importance  Several studies have documented that children gain more weight than expected after adenotonsillectomy.

Objectives  To examine patterns of change in weight and stature percentiles in children after adenotonsillectomy and to analyze clinical and demographic correlates of shifts in the growth curve.

Design, Setting, and Participants  In this retrospective medical record review, we studied patients 18 years and younger who underwent adenotonsillectomy at an academic pediatric tertiary medical center and had at least one height and weight measurement recorded at each of the following time points: within 3 months before surgery, within 3 to 9 months after surgery, and within 12 to 27 months after surgery. Data were procured from all children from January 1, 2007, through October 31, 2012, and initially included 2893 surgical patients and 161 458 height and weight measurements. The final database consisted of 815 patients with adequate growth data and multiple time points. Logistic regression analysis was performed to examine patient age at surgery, preoperative weight, sex, and ethnic background for correlations with changes in weight, height, and body mass index percentiles.

Main Outcomes and Measures  Change in weight, height, and body mass index percentile before and after surgery.

Results  At 18 months after surgery, weight percentiles in the study group increased by a mean of 6.3 percentile points (P < .001). Body mass index percentiles increased by a mean of 8.0 percentile points (P < .001). The greatest increases in weight percentiles were observed in children who were between the 1st and 60th percentiles for weight (P < .001) and younger than 4 years at the time of surgery (P < .001). An increase in weight percentile was not observed in children who preoperatively were already above the 80th percentile in weight (P = .15).

Conclusions and Relevance  Weight gain after adenotonsillectomy occurs primarily in patients who are smaller and younger at the time of surgery and does not correlate with increased rates of obesity.

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Figure 1.
Mean Change in Weight Percentile During a Postoperative Course of 0 to 72 Months

Weight percentile plateaued 1 year after surgery, with 90% of gain occurring by 4½ to 6 months.

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Figure 2.
Distribution of Change in Weight Percentile Based on Weight Percentile at Surgery and Age at Surgery

A, Children with a preoperative weight less than or equal to the 60th percentile had a mean increase of 12.4 percentile points, whereas children with a preoperative weight in the greater than 80th percentile had no increase. B, Children younger than 4 years had a mean increase of 10.7 points; children older than 8 years had a smaller increase (3.8 points).

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Figure 3.
Distribution of Change in Body Mass Index (BMI) Percentile After Adenotonsillectomy Stratified by Preoperative BMI Percentile

Children in the 1st to 20th percentiles for BMI (calculated as weight in kilograms divided by height in meters squared) increased from a mean preoperative percentile of 14.2 to a postoperative mean percentile of 36.9 (P < .001), whereas those in the 81st to 99th percentiles had no significant increase in BMI percentile (P = .15). *P < .001.

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