A Novel Proposal for Classifying Pediatric Tonsillectomy Complications: Modified Clavien Classification

Abstract

Introduction Tonsillectomy is one of the most common operations performed in the otolaryngology practice and there does not exist a systematic classification for tonsillectomy complications in the prior literature. In this study, we aimed at presenting a novel classification system to the current literature and analyzing complications of pediatric tonsillectomy based on this novel classification system. Methods A novel classification system based on modified Clavien classification was constituted for pediatric tonsillectomy complications. Medical records of 534 patients underwent tonsillectomy were retrospectively investigated and complication rates of tonsillectomy between children and adults were compared using this classification Results In total, 454 pediatric patients (258 males and 196 females, age range = 3-17 years) who underwent cold-knife tonsillectomy were eligible for the study. To compare the complication rates of the pediatric patients with adults, 80 adults with tonsillectomy (50 males and 30 females, age range 18-46) were also included. In children, the most common complication was dehydration, seen in 13 (2.86%) patients. The most serious complication was tooth aspiration (Grade 4a), seen in only one (0.22%) patient. Fifteen (3.3%) pediatric patients experienced more than one complication. Overall complication rate of pediatric tonsillectomy was 10.13% (46 patients). In adults, the most common complication was postoperative bleeding, seen in 11 (13.75%) adult patients. The most serious complication was Grade 3a postoperative bleeding, seen in four (5%) patients. Overall complication rate of adult tonsillectomy was 21.25% (17 patients). Overall complication rate of pediatric tonsillectomy was significantly lower compared with the complication rate of adult tonsillectomy (10.13% vs. 21.25%, p = 0.004, X 2 = 8.07). Conclusion Modified Clavien classification is a novel and simple tool to analyze and categorize complications of pediatric tonsillectomy.