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Acute Kidney Injury (AKI) After Pediatric Tonsillectomy: An Opportunity for Quality Improvement
Avivah J Wang1, Avani Vasireddy1, Jeffrey Cheng2
1Duke University School of Medicine, Durham, NC, USA.
Insights
Pediatric tonsillectomy patients may develop acute kidney injury (AKI) due to NSAID use and dehydration. Early recognition and management of AKI are crucial for preventing long-term health issues.
Area of Science:
- Pediatric Nephrology
- Surgical Outcomes
- Patient Safety
Background:
- Transient acute kidney injury (AKI) in children can lead to significant long-term health problems.
- Children undergoing tonsillectomy face unique risks for AKI, including NSAID use and perioperative dehydration.
Purpose of the Study:
- To determine the incidence of AKI in pediatric patients following tonsillectomy.
- To identify potential risk factors and areas for quality improvement in post-tonsillectomy AKI management.
Main Methods:
- A retrospective chart review of 3018 pediatric tonsillectomy patients was conducted.
- Emergency department visits within 30 days of surgery were analyzed for serum creatinine levels and AKI diagnosis.
Main Results:
- 9.8% of patients visited the ED within 30 days post-tonsillectomy.
- 7.3% of those with available creatinine values were diagnosed with AKI.
- One case showed AKI resolution within a year.
Conclusions:
- AKI following pediatric tonsillectomy is under-recognized.
- Quality improvement efforts should focus on NSAID use, dehydration monitoring, and AKI follow-up care.
Purpose:
There is emerging evidence showing even a single episode of transient acute kidney injury (AKI) in children can have negative long-term health consequences. AKI may be under-recognized in children undergoing tonsillectomy because of unique risk factors, such as recommended use of NSAIDs and restricted oral intake pre- and postoperatively.
Methods:
A consecutive case series with chart review was performed for patients under age 18 years at a single tertiary care institution who underwent tonsillectomy between July 1, 2013 and May 17, 2024, identified by CPT codes for tonsillectomy. ED visits within 30 days of surgery were documented. Serum creatinine values at ED visit were recorded, if available, and incidence of elevated serum creatinine and AKI were determined.
Results:
Charts of 3018 pediatric tonsillectomy patients were reviewed. About 295 (9.8% of 3018) had an ED visit within 30 days for any reason, of whom 110 (37.3% of 295) had a serum creatinine value at this ED visit. Of these, 13 (11.8% of 110) had elevated serum creatinine, and 8 (7.3% of 110) had AKI by standardized criteria. One patient had a follow-up serum creatinine performed within 1 year which showed resolution of AKI.
Conclusion:
Incidence of AKI following tonsillectomy has not been previously well recognized. Identification of previously unrecognized risks from post-tonsillectomy AKI represents an important potential area for quality improvement, including careful patient selection for use of non-steroidal anti-inflammatory drugs, close monitoring of those at higher risk for dehydration after surgery, and follow-up care for those diagnosed with AKI.
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