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Published on: November 6, 2019
Complications of turbinate reduction surgery in combination with tonsillectomy in pediatric patients
Sonia N Yuen1, Peggy P Leung1, Jamie Funamura1
1Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.
Insights
Combining turbinoplasty with tonsillectomy and adenoidectomy (T&A) does not increase complication risks. Pediatric patients can avoid risks from multiple anesthetics by undergoing these procedures together.
Area of Science:
- Otolaryngology
- Pediatric Surgery
Background:
- Tonsillectomy and adenoidectomy (T&A) are common procedures for pediatric airway obstruction.
- Turbinoplasty is often performed to address nasal obstruction.
- The safety of combining turbinoplasty with T&A is not well-established.
Purpose of the Study:
- To determine if adding turbinoplasty to T&A increases postoperative complications in children.
- To compare complication rates between T&A with turbinoplasty, T&A alone, and turbinoplasty alone.
Main Methods:
- Retrospective cohort study using the 2016 Pediatric Health Information System database.
- Included 75,761 children (≤18 years) undergoing T&A and/or turbinoplasty between July 2013 and June 2015.
- Compared 14-day postoperative revisit, hemorrhage requiring cautery, and blood transfusion rates among three groups.
Main Results:
- No significant difference in 14-day revisit rates between combined T&A and turbinoplasty (9.4%) versus T&A alone (8.6%).
- Hemorrhage requiring cauterization rates were similar: 1.4% for combined procedures vs. 1.5% for T&A alone.
- No blood transfusions were required in the combined or turbinoplasty-alone groups; 21 patients (T&A alone) required transfusion.
Conclusions:
- Combined turbinoplasty and T&A is safe, not increasing risks of postoperative revisit or hemorrhage.
- Performing these procedures concurrently can benefit pediatric patients by avoiding repeat anesthetics and intubations.
- The combined procedure is a viable option for managing pediatric airway issues.
Objectives/Hypothesis:
To examine whether the addition of turbinoplasty to tonsillectomy and adenoidectomy (T&A) increases the risk of postoperative complications.
Study Design:
Retrospective cohort study of children (18 years old and younger) who underwent tonsillectomy and/or turbinoplasty between July 1, 2013 and June 30, 2015 using the 2016 Pediatric Health Information System administrative database METHODS: Patients were divided into three groups: 1) T&A and turbinoplasty, 2) T&A alone, and 3) turbinoplasty alone. Postoperative revisit, hemorrhage requiring cautery, and blood transfusion rates were compared between groups.
Results:
A total of 75,761 patients met inclusion criteria: 3,079 underwent both T&A and turbinoplasty, 72,043 underwent T&A alone, and 639 underwent turbinoplasty alone. The rate of 14-day relevant revisits after T&A in combination with turbinate reduction surgery was not significantly higher than that of T&A alone (9.4% vs. 8.6%; P = .11). The revisit rate after turbinoplasty alone was 1.4%. Indications for revisits did not differ between the T&A and turbinoplasty group versus T&A alone group (P = .23). Furthermore, the rates of hemorrhage requiring cauterization was similar between the two groups (1.4% vs. 1.5%; P = .64). Twenty-one patients who underwent T&A alone required blood transfusion after they were readmitted; no cases in the other two groups required blood transfusion.
Conclusions:
Turbinoplasty and T&A performed together do not increase the risk of postoperative revisit or hemorrhage requiring cauterization, and can therefore be considered as a combined procedure. Pediatric patients will benefit from avoiding the additional risk of multiple anesthetics and repeated intubation.
Level Of Evidence:
4. Laryngoscope, 127:1920-1923, 2017.
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