Researchers in Southampton have said the lack of data on overweight children presenting for surgery in the UK may be putting them at greater risk of complications.
While obese adults are considered to be high-risk and are subject to national guidelines for surgical treatment, there is currently little understanding of anaesthetic implications on obese children.
High risk of complications
Approximately 500,000 children undergo anaesthesia and surgery in England alone every year and, according to the National Child Measurement Programme (NCMP), 9.5% of four to five year olds in England were obese in 2017-18, with a further 12.8% overweight.
These proportions were higher among those aged 10 to 11, with 20.1% obese and 14.2% overweight.
Whether a person is underweight, of normal weight, overweight or obese is determined by Body Mass Index (BMI), which is a measure of body fat based on age, gender, height and weight.
Overweight or obese children may suffer from undiagnosed conditions such as hypertension, type 2 diabetes and asthma, which increase the risks of surgery.
While it is anticipated all hospitals routinely measure weight, some do not routinely measure height prior to a procedure under general anaesthesia – this prevents BMI from being calculated so medical staff are not alerted to the obese or overweight status of a child.
“The current incidence of childhood obesity and the burden of complications in children presenting to UK hospitals for surgery is largely unknown,” said Dr Mark Edwards, a consultant in anaesthesia and perioperative medicine at University Hospital Southampton.
“Adults in this category are deemed to be high-risk during and after surgery with a higher incidence of airway complications.
“Yet while there are published national guidelines on the best-practice management of these adult patients in the surgical period, no guidance exists for children or, indeed, any idea of prevalence which puts them at risk of complications.”
The PEACHY study
Now, in a study led by the Paediatric Anaesthetic Trainee Research Network (PATRN) and Dr Edwards at UHS, all UK hospitals performing general anaesthesia for children aged two to 16 years have been invited to collect data on all of those weighing more than 12kg.
The PATRN is a group of specialist trainee doctors involved in research alongside everyday clinical practice, with the study, known as PErioperAtive CHildhood obesitY (PEACHY), developed by members Dr Zoë Burton, Dr Rosie Lewis and Dr Tom Bennett.
“Since obesity is associated with increased risk of critical airway complications during surgery and recovery from general anaesthesia, defining prevalence is an important clinical question,” said Dr Burton, joint trainee lead for the study.
“US studies suggest up to a third of paediatric patients are overweight or obese and other non-UK research shows this patient group requires longer in post-operative anaesthetic care, more medication to prevent vomiting and nausea and are at greater risk of airway complications.
“Obtaining this data in the UK may indicate that there are adjustments that should routinely be made to anaesthetic technique, for example, some of these children may benefit from more formal pre-operative assessment in advance of surgery.”
She added: “Additionally, obese children may be at risk of drug under or overdosing, however, there is very little evidence of how we should be adjusting doses for obese children and this is an area in need of urgent investigation.”
Professor Russell Viner, president of the Royal College of Paediatrics and Child Health, said: “Almost one in five children are overweight or obese by the time they start primary school, rising to one in three by the time they start secondary school.
“With estimates showing that half of all children will be overweight or obese by the end of the decade, it’s crucial that parents understand the associated health risks for their children both now and as they grow into adults.
“We know that obesity has links to conditions that will affect children throughout their lifetimes like type 2 diabetes and cardiovascular disease, however, less is currently known about the impact that obesity can have when children undergo surgery under general anaesthetic.
“We therefore welcome this study and the difference its findings could make to the health and safety of young people undergoing surgery in the UK.”
For more information on the study, which is funded by the Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI) and is the first national paediatric anaesthetic study delivered by a trainee research network, visit https://www.apagbi.org.uk/professionals/trainee-section/research-network-patrn/peachy
Posted on Thursday 10 October 2019