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Population-based study of congenital heart disease and revisits after pediatric tonsillectomy

Rebecca Miller1, Dmitry Tumin1,2, Christopher McKee1,3

  • 1Department of Anesthesiology and Pain Medicine Nationwide Children's Hospital Columbus Ohio.

Laryngoscope Investigative Otolaryngology
|March 5, 2019
PubMed

Insights

Congenital heart disease (CHD) did not increase the risk of revisits after pediatric tonsillectomy and adenoidectomy (T/A). Other factors like non-cardiac comorbidities are more predictive of post-T/A revisits.

Area of Science:

  • Pediatric Surgery
  • Cardiology
  • Health Services Research

Background:

  • Risk stratification is crucial for pediatric surgery, especially elective procedures like tonsillectomy and adenoidectomy (T/A).
  • Congenital heart disease (CHD) is a potential risk factor that requires careful consideration in surgical risk assessment.
  • T/A procedures, while common, can be associated with a notable rate of adverse events and revisits.

Purpose of the Study:

  • To investigate the association between congenital heart disease (CHD) and the risk of 30-day revisits following T/A in children.
  • To determine if the severity of CHD influences the likelihood of readmission or emergency department visits after T/A.
  • To identify key predictors of revisits in pediatric patients undergoing T/A.

Main Methods:

  • Utilized State Inpatient Databases and State Ambulatory Surgery and Services Databases from five US states (2010-2014).
  • Identified a cohort of pediatric patients who underwent T/A.
  • Employed multivariable logistic regression to assess the association between CHD severity and 30-day revisits, controlling for other factors.

Main Results:

  • The study included 244,598 patients, with 858 having minor or major CHD.
  • Congenital heart disease (CHD) was not significantly associated with an increased risk of 30-day revisits after T/A (minor CHD OR=1.1, P=.65; major CHD OR=1.2, P=.34).
  • Other comorbidities, including chromosomal anomalies, congenital airway anomalies, and neuromuscular impairment, were associated with a higher likelihood of revisits.

Conclusions:

  • Neither minor nor major CHD independently predicts an increased risk of 30-day revisits in children undergoing T/A.
  • Non-cardiac comorbidities, socioeconomic status, and geographic region may be more valuable for predicting revisit risk after pediatric T/A.
  • Current risk stratification for T/A may benefit from incorporating a broader range of patient characteristics beyond cardiac conditions.
Abstract

Keywords:
Congenital heart diseaserisk stratificationtonsillectomy

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