The Association of Steroids and Pediatric Post-Tonsillectomy Recovery: A Retrospective Review

Pain, dehydration, and bleeding remain significant concerns for pediatric tonsillectomy patients. The literature is sparse on potential effects of postoperative, outpatient steroid prescribing practices among the post-tonsillectomy pediatric population. We aim to investigate the association of a postoperative oral steroid course with pain, bleeding, and dehydration while controlling for infectious indication to guide physicians for appropriate management of this population.

Single institution, retrospective review of pediatric patients aged 2-18 years who underwent tonsillectomy from 2019 to 2021. One group received a 4-dose course of postoperative oral dexamethasone, and the other did not. Among patients ages 2-6 and 7-18, the association of steroids with emergency department visits related to bleeding, dehydration, or uncontrolled pain was estimated while controlling for infectious indication and other factors.

There were 2054 pediatric tonsillectomy patients included. The majority were male (50.8%) and Non-Hispanic White (63.7%) with an average age of 7.0 years (SD = 3.9). About one-third (30.4%) of patients received dexamethasone, and dexamethasone was not associated with significantly lower odds of bleeding, dehydration, or uncontrolled pain/pain medication refills.

A 4-dose course of postoperative dexamethasone was not associated with a significant reduction in post-tonsillectomy bleeding, dehydration, or pain when controlling for infectious indication. However, it may be reasonable as an adjunct therapy.

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