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Trends in postoperative complications following pediatric tonsillectomy & adenoidectomy: A 10-year analysis
Ogechukwu S Anwaegbu1, Delaney E S Clark1, Samsudeen O Iyamah1
1John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX 77554, USA.
Insights
Post-tonsillectomy complications like hemorrhage and pain are increasing in children and adolescents, while dehydration and respiratory issues are declining. Persistent racial disparities in complication rates were observed over a decade.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Public Health
Background:
- Tonsillectomy with or without adenoidectomy is a common pediatric surgical procedure.
- Understanding post-operative complication trends and risk factors is crucial for improving patient outcomes.
- Variations in complication rates across age groups, comorbidities, and social determinants of health require investigation.
Purpose of the Study:
- To assess the 10-year incidence of post-operative complications following tonsillectomy with/without adenoidectomy in pediatric patients.
- To compare complication rates between young children (0-9 years) and adolescents (10-17 years).
- To examine the influence of comorbidities, social determinants of health, race, and gender on these complications.
Main Methods:
- Retrospective cohort study utilizing the TriNetX database (2014-2023) of 197,885 pediatric patients (ages 0-17).
- Analysis of 5 key post-operative outcomes within 30 days, stratified by age, gender, race, and ethnicity.
- Propensity score matching was used to compare early childhood and adolescent cohorts (n=56,036 each).
Main Results:
- The most frequent complications were pain (3.1%), post-operative hemorrhage (2.3%), dehydration (2.1%), infection (0.26%), and acute respiratory complications (0.21%).
- The early childhood cohort showed higher risks related to socioeconomic/psychosocial factors (p=0.013) and environmental tobacco smoke (p=0.016).
- No significant differences in overall complication risks were found between the early childhood and adolescent groups post-matching.
Conclusions:
- Dehydration and acute respiratory distress rates have decreased, while post-operative hemorrhage and pain rates have increased.
- Persistent racial disparities in complication rates were noted.
- Further research into the impact of social determinants and specific risk factors is warranted.
Objective:
Assess the rates of post-operative complications following tonsillectomy with/without adenoidectomy over a 10-year span, comparing young children and adolescents, while examining the influence of comorbidities, social determinants of health, and potential racial, and gender differences.
Methods:
A retrospective cohort study using TriNetX database with de-identified electronic medical records from 57 healthcare organizations for ages 0-17 who had tonsillectomy with/without adenoidectomy from January 2014 to December 2023. Risk analysis and incidence proportion over a 10-year period for 5 outcomes occurring within 30 days, stratified by gender, race, and ethnicity. Then further subdivided into two groups: Early Childhood (0-9 years) and Adolescence (10-17 years). Statistical analysis included risk ratios (RR), and 95 confidence intervals (CI), with statistical significance set at p ≤ 0.05.
Results:
Before propensity score matching, 197,885 pediatric patients were identified. Most common complications occurring within 30 days were pain (3.1 %), post-operative hemorrhage (2.3 %) with 1.3 % requiring re-operation for control, dehydration (2.1 %), infection (0.26 %), and acute respiratory complications (0.21 %). Before propensity score matching, Early Childhood cohort (0-9 years: n = 71,024) and Adolescence cohort (10-17 years: n = 126,861). After propensity matching, n = 56,036 for both groups. Early Childhood cohort had higher rates for potential health hazards related to socioeconomic and psychosocial circumstances (p = 0.013) and environmental tobacco smoke exposure-related risks (p = 0.016) than Adolescence cohort. No significant differences in complication risks were observed between the two pediatric age groups.
Conclusion:
Rates of dehydration and acute respiratory distress have declined, while post-operative hemorrhage, and pain have been increasing, and observable racial differences continue to persist within these complications.
Level Of Evidence:
III.
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