Post-tonsillectomy Respiratory Complications in Children With Obesity: Systematic Review and Meta-analysis
In brief
Obese children had nearly twice the odds of breathing complications after tonsil surgery
Across 18 studies of 60,044 children, respiratory complications occurred in 12.2% of those with obesity versus 7.6% without. The increased odds appeared in studies counting problems in the recovery unit, but not in those limited to inpatient wards; the findings suggest children without recovery-room complications may be safe to discharge, though the evidence does not settle that question.
- Journal
- Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (Q1)
- Published
- 29 September 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Erin M Kirkham, Nikhila Raol, Sharmi C Amin, Bo Hyun Kong, Aayush Sharma, Ahab Chopra, et al.
- PMID
- 42808640
- DOI
- 10.1002/ohn.70455
Why clinicians should know about it
- Picked for Otorhinolaryngology (paper of the day, 30 September 2026): Obesity increases post‑tonsillectomy respiratory risk
Abstract
OBJECTIVE: To quantify and compare the risk of respiratory complications between children with and without obesity after tonsillectomy (with or without adenoidectomy). DATA SOURCES: Ovid MEDLINE, Embase, CINAHL, and Clarivate Web of Science. REVIEW METHODS: Studies that reported post-tonsillectomy respiratory complications in patients <18 years old were included. Quality assessment was performed using National Heart, Lung, and Blood Institute quality assessment tools. Meta-analysis of odds ratios with 95% confidence interval (CI) was calculated using random-effects models. Subgroup analyses divided studies by phase of care of event (inpatient only vs post-anesthesia care unit [PACU] or inpatient), indication for tonsillectomy (any vs only sleep-disordered breathing), and medical complexity (>20% with medical comorbidity vs ≤20%). RESULTS: In total, 18 studies representing 60,044 patients were included. The mean age at surgery ranged from 4.0 to 9.2 years, and 7.8% were obese (>95th body mass index percentile for age and weight). The overall frequency of complications was 8.0%: 12.2% in children with obesity and 7.6% in children without. Compared to children without, those with obesity had significantly increased odds of a complication (odds ratio [OR] 1.86 [95% CI 1.38-2.49, I2 = 77.5%]). Obesity did not increase the odds among studies that excluded PACU complications. CONCLUSION: Pediatric patients with obesity have nearly twice the odds of post-tonsillectomy respiratory complications than those without. However, odds were elevated only in studies that included events in PACU but not in studies limited to the inpatient wards. Discharge may be safe for children with obesity who do not develop complications in PACU.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.