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Published on: November 6, 2019
Risk Factors Associated With Pediatric Post-Tonsillectomy Complications: A Focus on Racial, Ethnic and Socioeconomic
Emily Wikner1, Catherine Nguyen1, Turaj Vazifedan2
1Department of Otolaryngology, Eastern Virginia Medical School - Macon & Joan Brock Virginia Health Sciences at Old Dominion University; Norfolk, VA, USA.
Insights
This study found no racial/ethnic or socioeconomic disparities in pediatric tonsillectomy complications. Intracapsular tonsillectomy showed fewer complications than total electrocautery, indicating technique impacts outcomes.
Area of Science:
- Pediatric Otolaryngology
- Health Services Research
- Surgical Outcomes
Background:
- Tonsillectomy is a common pediatric procedure with known risks like bleeding and dehydration.
- Existing research highlights disparities in other pediatric otolaryngic conditions, but tonsillectomy disparities are understudied.
Purpose of the Study:
- To investigate potential racial/ethnic and socioeconomic disparities in post-operative complications following pediatric tonsillectomy.
- To identify factors influencing complication rates in children undergoing tonsillectomy.
Main Methods:
- Retrospective case control study of 1751 pediatric patients undergoing tonsillectomy from 2019-2020.
- Data collected included demographics, race, ethnicity, insurance type, surgical technique, and post-operative complications (hemorrhage, pain, dehydration).
Main Results:
- Overall complication rate was 7%, with 2.3% experiencing hemorrhage and 4.6% dehydration/poor pain control.
- No statistically significant differences in complication rates were found based on race, ethnicity, or insurance type.
- Intracapsular tonsillectomy was associated with a significantly lower likelihood of complications compared to total electrocautery.
Conclusions:
- The study found no evidence of racial/ethnic or socioeconomic disparities in pediatric tonsillectomy complications.
- Surgical technique, specifically intracapsular tonsillectomy, appears to be a significant factor in reducing complication risk.
- Further research into regional disparities across the United States is warranted.
Objectives:
Though a common procedure, tonsillectomy is often associated with significant risks such as bleeding, odynophagia, and dehydration. There has been some research investigating racial/ethnic and socioeconomic disparities in other pediatric otolaryngic issues such as otitis media and sleep disordered breathing. However, there is a paucity of research regarding disparities in children undergoing tonsillectomy.
Methods:
A retrospective case control study was performed on all pediatric patients who underwent tonsillectomy with or without adenoidectomy from January 1, 2019 to December 31, 2020 at a tertiary care center. Patient records were documented including demographics, race, ethnicity, type of insurance, surgical technique, and post-operative complications. A major post-operative complication was defined as post-surgical hemorrhage, uncontrolled pain, or dehydration requiring medical attention.
Results:
There were 1751 patients included in the study with an average age of 6.7 years old with 55.3% patients white, 41.6% black and 3% identified as another race and 8% patients Hispanic or Latino. A complication occurred in 7% of patients including 2.3% who experienced a post-operative hemorrhage and 4.6% with dehydration or poor pain control. Among the entire cohort, 64.2% were publicly insured while 35.8% had private insurance and 1.2% were self-pay.There was no statistically significant difference in terms of probability of complication among patients with different races (P = .85), ethnicities (P = .18) or insurance type (P = .48). Those with bleeding complications were found to be significantly older (P = .011). There was a statistically significant lower likelihood of complication in patients who underwent intracapsular tonsillectomy compared to total electrocautery tonsillectomy (P < .001).
Discussion:
We found no racial/ethnic or socioeconomic disparities in the risk of post-operative complications in children who underwent tonsillectomy. Despite the frequency of tonsillectomy in children, there are few studies addressing inequalities. Further investigation of disparities in other regions of the United States should be performed.
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