ASPO026 - Weight Gain Following Tonsillectomy Does Not Occur in Continuous Positive Airway Pressure Patients
Saturday, April 30, 2022
1:55 PM – 2:30 PM CT
Location: Landmark C
Thomas K. Chung, MD, MA1, Tatiana Yeung, B.S.2, Umakanth Katwa, MD3, Gi-Soo Lee, MD, MEd2;
1Otolaryngology Head & Neck Surgery, Penn State Children's Hosp., Hershey, PA, 2Otolaryngology & Communication Enhancement, Boston Children's Hosp., Boston, MA, 3Pulmonology, Boston Children's Hosp., Boston, MA
Assistant Professor Penn State Children's Hospital Hershey, Pennsylvania
Introduction: Post-tonsillectomy weight gain (PTWG) in children is a phenomenon that is poorly understood. One possible cause is that tonsillectomy improves airway patency thereby decreasing the energy expended to breathe at night, resulting in weight gain. If decreased energy expenditure following tonsillectomy drives PTWG, then we hypothesize that children using continuous positive airway pressure (CPAP) would also experience post-treatment weight gain.
Methods: Children ages 2 to 18 who underwent tonsillectomy or CPAP between 2012 to 2019 with anthropomorphic and polysomnographic data at treatment initiation and 180 to 365 days following treatment initiation were compared. Subanalyses on tonsillectomy indication and age were performed. A BMI z-score change of ≥ 0.2 was considered clinically significant per U.S. Preventative Service Task Force standards.
Results: A total of 3162 patients were identified including 236 CPAP patients, 545 tonsillectomy for OSA (tOSA), and 2381 patients for sleep-disordered breathing with or without recurrent tonsilitis (tSDB). CPAP patients were older than tonsillectomy patients (CPAP 10.5±5.0 vs tOSA 9.0±4.6 vs tSDB 6.2±3.8 years, p<0.001). The tonsillectomy for OSA group had the highest proportion of preoperative overweight or obese patients (CPAP 44% vs tOSA 62% vs tSDB 44%). Change in BMI z-score was highest in both tonsillectomy groups compared to CPAP (CPAP 0.07±1.14 vs tOSA 0.14±0.64 vs tSDB 0.34±0.89, p<0.001). This relationship was most apparent in the normal and overweight patients. For the 781 patients with polysomnography data, the tonsillectomy for OSA group had slightly higher preoperative obstructive AHI (9.0±15.8 vs CPAP 8.0±24.0, p=0.013) but similar post-treatment change (-8.9±16.5 vs CPAP -5.6±27.4, p=0.33). Younger age correlated with higher BMI z-score increases for the normal weight subcohort but age did not contribute to differences in BMI z-score in any other preoperative BMI category. 49% of patients in this study had a clinically-significant BMI z-score increase of ≥0.2.
Conclusion: Weight gain after tonsillectomy appears to be unique to tonsillectomy and does not extend to CPAP. Further studies are needed to better characterize PTWG.