Mortality and major morbidity after tonsillectomy

Goldman, Julie; Baugh, Reginald F.; Davies, Louise; Skinner, Michael; Stachler, Robert J.; Brereton, Jean; Eisenberg, Lee; Roberson, David W.; Brenner, Michael

doi:10.1002/lary.23926

Cited by 116 publications

(43 citation statements)

References 54 publications

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“…A review of the FDA's Adverse Event Reporting System for a 43 year period (1969–2012) revealed 13 cases of pediatric codeine‐related death, with 11/13 occurring after adenotonsillectomy and seven being confirmed as ultrarapid metabolizers of codeine . These findings, along with published reports of additional pediatric post‐tonsillectomy deaths related to ultrarapid metabolism of codeine, formed the basis for the February 2013 issuance of the FDA's boxed warning and contraindication regarding the use of codeine in the setting of pediatric tonsillectomy and/or adenoidectomy . Codeine had long been a mainstay of pediatric post‐tonsillectomy care, being available in generic form and typically compounded with acetaminophen, increasing its utility for postoperative pain and inflammation.…”

Section: Discussionmentioning

confidence: 93%

Otolaryngology practice patterns in pediatric tonsillectomy: The impact of the codeine boxed warning

2017

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Objectives/Hypothesis: To determine if otolaryngologists at a single children's hospital were adherent to the boxed warning for codeine use in post-tonsillectomy patients and the implications for practice patterns.Study Design: Case series with chart review. Methods: Charts from all patients undergoing adenotonsillectomy at a single children's hospital from January 1, 2010 through December 31, 2015 were analyzed and stratified according to date (pre-or post-boxed warning) and practitioner type (academic otolaryngologists [AO] vs. nonacademic otolaryngologists [NAO]). Demographic data, surgical technique, method of removal, narcotic prescriptions (dosage and drug), and complications were recorded. Fisher exact test was used to determine the level of significance in prescription rates pre-and postwarning. SPSS version 22 was used for statistical analysis, with P < .05 indicating statistical significance.Results: There were 2,749 children undergoing adenotonsillectomy during the study period, with 1,239 AOs and 1,510 NAOs. There was a distinct downward trend in codeine prescriptions before and after the warning, with the AO group reaching zero sooner than the NAO group. There was a 5% decrease in discharge narcotic prescriptions given postwarning (P < .001), but no significant difference in postoperative emergency department visits or pain-related complications when comparing the two time periods.Conclusions: Codeine use for management of pediatric post-tonsillectomy pain was essentially zero after issuance of the boxed warning. Total narcotic use decreased significantly without increase in pain-or medication-related complications. Future research should focus on identifying markers of increased susceptibility to adverse medication events and determining the safest options for pain management.

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Section: Discussionmentioning

confidence: 93%

Otolaryngology practice patterns in pediatric tonsillectomy: The impact of the codeine boxed warning

2017

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“…While recent evidence reveals that the most common reason for AT in the United States is OSA [27], it is important to acknowledge that this commonly performed surgery is not without risk. Morbidities can range from relatively minor hemorrhage and dehydration to more severe complications including anoxic brain injury and death [57],[58].…”

Section: Discussionmentioning

confidence: 99%

Association of Adenotonsillectomy with Asthma Outcomes in Children: A Longitudinal Database Analysis

et al. 2014

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“…However, more severe complications may occur, including hemorrhage, respiratory decompensation, velopharyngeal incompetence, subglottic stenosis, and rarely death 12 . There are a number of identified risk factors for post-operative complications, including age younger than 3 years, obesity, comorbid airway anomalies, Down syndrome and other genetic syndromes, craniofacial abnormalities and neuromuscular disease 13–18 . However, most of the studies that identified these risk factors were based on retrospective data 9 from heterogeneous populations, have often not included polysomnographic (PSG) documentation of OSAS, and have used different definitions of postoperative complications.…”

Section: Introductionmentioning

confidence: 99%

Complications of adenotonsillectomy for obstructive sleep apnea in school-aged children

Konstantinopoulou

Gallagher

Elden

et al. 2015

International Journal of Pediatric Otorhinolaryngology

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Introduction Adenotonsillectomy is the treatment of choice for most children with obstructive sleep apnea syndrome, but can lead to complications. Current guidelines recommend that high-risk children be hospitalized after adenotonsillectomy, but it is unclear which otherwise-healthy children will develop post-operative complications. We hypothesized that polysomnographic parameters would predict post-operative complications in children who participated in the Childhood AdenoTonsillectomy (CHAT) study. Methods Children in the CHAT study aged 5–9 years with apnea hypopnea index 2–30/hr or obstructive apnea index 1–20/hr without comorbidities other than obesity/asthma underwent adenotonsillectomy. Associations between demographic variables and surgical complications were examined with Chi square and Fisher’s exact tests. Polysomnographic parameters between subjects with/without complications were compared using Mann-Whitney tests. Results Of the 221 children (median apnea hypopnea index 4.7/hr, range 1.2–27.7/hr; 31% obese), 16 (7%) children experienced complications. 3 (1.4%) children had respiratory complications including pulmonary edema, hypoxemia and bronchospasm. Thirteen (5.9%) had non-respiratory complications, including dehydration (4.5%), hemorrhage (2.3%) and fever (0.5%). There were no statistically significant associations between demographic parameters (gender, race, and obesity) or polysomnographic parameters (apnea hypopnea index, % total sleep time with SpO2<92%, SpO2 nadir, % sleep time with end-tidal CO2>50 Torr) and complications. Conclusions This study showed a low risk of post-adenotonsillectomy complications in school-aged healthy children with obstructive apnea although many children met published criteria for admission due to obesity, or polysomnographic severity. In this specific population, none of the polysomnographic or demographic parameters predicted post-operative complications. Further research could identify the patients at greatest risk of post-operative complications.

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Mortality and major morbidity after tonsillectomy

Abstract: N/A.

Cited by 116 publications

References 54 publications

Otolaryngology practice patterns in pediatric tonsillectomy: The impact of the codeine boxed warning

Otolaryngology practice patterns in pediatric tonsillectomy: The impact of the codeine boxed warning

Association of Adenotonsillectomy with Asthma Outcomes in Children: A Longitudinal Database Analysis

Complications of adenotonsillectomy for obstructive sleep apnea in school-aged children

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