Predictors of Complications of Tonsillectomy With or Without Adenoidectomy in Hospitalized Children and Adolescents in the United States, 2001-2010

Allareddy, Veerajalandhar; Martinez-Schlurmann, Natalia; Rampa, Sankeerth; Nalliah, Romesh; Lidsky, Karen; Allareddy, Veerasathpurush; Rotta, Alexandre T.

doi:10.1177/0009922815616885

Cited by 38 publications

(53 citation statements)

References 39 publications

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“…Parents may also have felt more obligated to complete the questionnaire as part of their responsibility for their child's health, which may be a stronger motivator than adult patients' responsibility to themselves for their own health. Consistent with prior studies, there were more females in our adult sample [2,[7][8][9] and more males in our pediatric sample [2,8,10,11]. However, there were no differences in mail response rates between male and female patients in this study, regardless of their age group.…”

supporting

confidence: 90%

Self-Reported Complications after Tonsillectomy: Comparison of Responders and Nonresponders to a Mailed Questionnaire

Haye

Døsen

TarAngen

et al. 2020

International Journal of Otolaryngology

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Some studies of tonsillectomy outcomes have low response rates to mailed quality control questionnaires. is study evaluated the effect of nonresponders to mailed questionnaires about posttonsillectomy complications by determining whether mail responders and nonresponders differ. Questionnaires were mailed to patients 3-6 weeks after tonsillectomy to assess postoperative complications, defined as contact with a private practitioner and/or hospital readmission related to postsurgical bleeding, pain, or infection. Nonresponders to the mailed questionnaire were interviewed by telephone 7-11 weeks postoperatively, and responses of mail and telephone responders were compared. Of 818 patients undergoing tonsillectomy during the study period, 66.3% responded by mail, and 29.5% were interviewed by telephone, for a total response rate of 95.7%. e mail response rate was significantly higher among parents of pediatric patients than among adult patients (71.4% versus 58.7%, p < 0.001). In the pediatric group, overall complication rates were 65% higher among mail responders than telephone responders (20.9% versus 12.7%, p � 0.049), likely due to their higher rates of both visits to private practitioners and infection, as there were no differences in rates of pediatric readmission, bleeding, or pain between the responder groups. Among adult patients, mail and telephone responders did not differ with respect to their overall complication rate (40.9% versus 34.1%, p � 0.226) or their rates of readmission or bleeding. However, similar to the pediatric group, visits to a private practitioner were slightly more common among adult mail responders than telephone responders (30.6% versus 21.1%, p � 0.065), as were reports of pain (p � 0.001) and infection (p � 0.006). Studies relying on mailed questionnaires with low response rates likely overestimate the rate of minor complications handled outside the hospital, but rates of major complications involving readmission are unlikely to be seriously biased by low response rates. Supplementing mailed questionnaires with telephone interviews may increase the validity of surgical outcome studies.

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supporting

confidence: 90%

Self-Reported Complications after Tonsillectomy: Comparison of Responders and Nonresponders to a Mailed Questionnaire

Haye

Døsen

TarAngen

et al. 2020

International Journal of Otolaryngology

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“…10 Certain comorbid conditions, such as anemia and chronic pulmonary disease, may increase a patient's risk of complications. 29 Syndromic patients and obese patients have also been shown to be at higher risk for postoperative complications. 30 Perioperative medications may also contribute to increased likelihood of PTH.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Multiple Hemorrhages Following Tonsil Surgery in Children

et al. 2018

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Objectives/Hypothesis Although much is known about the incidence and risk factors for hemorrhage after tonsil surgery, the incidence and factors related to multiple episodes of hemorrhage are not well examined. Our objective was to identify risk factors that may contribute to multiple hemorrhages following tonsil surgery in children. Study Design Retrospective chart review. Methods A retrospective review was conducted of pediatric patients who experienced one or more hemorrhages following tonsillectomy/tonsillotomy, with or without adenoidectomy, between 2010 and 2016 at a single, tertiary‐care hospital. Risk factors for multiple hemorrhages were examined using a multivariable logistic regression model. Results Among the 11,140 patients who underwent tonsil surgery, 452 patients experienced one or more hemorrhages; 32 of these had multiple episodes of hemorrhage (7.1% of all patients with bleeds/0.3% of all patients). Older age (≥12 years: adjusted odds ratio [OR]: 3.13; 95% confidence interval [CI]: 1.47‐6.68) and high body mass index for age (≥85th percentile: adjusted OR: 2.26; 95% CI: 1.06‐4.85) were significantly associated with an increased risk of multiple hemorrhages in the multivariable model. Medical comorbidities, indications for surgery, surgical technique, intraoperative blood loss, and perioperative medications were not associated with multiple episodes of bleeding. Conclusions Multiple hemorrhages after tonsillectomy/tonsillotomy are uncommon. The risk of a second PTH after an initial episode is 7.1%, almost double the risk of a bleed after the initial tonsil surgery. Age > 12 years and high BMI for age may be associated with increased risk of rebleeding. After an initial bleed, increased surveillance may be warranted, particularly for patients with risk factors. Level of Evidence 4 Laryngoscope, 129:2765–2770, 2019

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“…Tonsillectomy, with and without adenoidectomy, is a frequently performed surgical procedure for children world‐wide . Tonsillectomies are mainly performed for the treatment of adenotonsillar hypertrophy (resulting in sleep‐disordered breathing) and recurrent tonsillitis .…”

mentioning

confidence: 99%

“…Tonsillectomies are mainly performed for the treatment of adenotonsillar hypertrophy (resulting in sleep‐disordered breathing) and recurrent tonsillitis . However, despite its safe reputation, tonsillectomies are associated with significant risk of morbidity and delays to recovery . Post‐operative complications include bleeding, respiratory compromise, infection, dehydration, pain, nausea and vomiting .…”

mentioning

confidence: 99%

“…However, despite its safe reputation, tonsillectomies are associated with significant risk of morbidity and delays to recovery . Post‐operative complications include bleeding, respiratory compromise, infection, dehydration, pain, nausea and vomiting . These adverse events are associated with patient suffering and additional health resource utilisation associated with prolonged hospital admission and emergency presentations …”

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confidence: 99%

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Impact of paediatric tonsillectomy perioperative management on pain, nausea and recovery: A prospective cohort study

Richards

Lang

Andresen

et al. 2019

J Paediatrics Child Health

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Aim: Tonsillectomy procedures are a core element of paediatrics; however, perioperative management differs. This study aimed to describe tonsillectomy management, including the burden of pain, nausea and delayed recovery. Methods: A prospective cohort study was undertaken through an audit of tonsillectomy perioperative practice and recovery and survey interviews with family members 7-14 days post-surgery. The study was undertaken at an Australian tertiary referral paediatric hospital between June and September 2016. Results: The audit included 255 children undergoing tonsillectomy, with 127 family members interviewed. Most participants underwent adenotonsillectomy (n = 216; 85%), with a primary diagnosis of obstructive sleep apnoea (n = 205; 80%) and a mean age of 7 years (standard deviation; 3.9). A variety of intra-operative pain relief and antiemetics was administered. Pain was present in 29% (n = 26) of participants at ward return, increasing to 32-45% at 4-20 h and decreasing to 21% (n = 15) at discharge. A third of the children (32%; n = 41) had moderate to severe pain at post-discharge interview, and 30% (n = 38) experienced nausea at home. Most parents (82%; n = 104) were still giving regular paracetamol at 7 days post-operatively, and 31% (n = 39) had finished their oxycodone. Of the participants, 14% (n = 26) presented to the emergency department within 7 days of discharge; 8% (n = 20) of the total cohort were re-admitted. Conclusions: There was variety in perioperative and post-discharge care. Pain scores were infrequently documented post-tonsillectomy, and parents are generally dissatisfied with the management of post-operative pain and nausea. Further research is needed to provide a more consistent approach to perioperative management to promote recovery.What is already known on this topic 1 Tonsillectomy is a commonly performed procedure in children. 2 Significant risk of morbidity and delays to recovery continue to exist. 3 Post-operative pain, nausea and vomiting, bleeding and infection remain problematic, contributing to re-presentation to emergency departments and readmission rates. What this paper adds1 Pain scores are infrequently documented post-tonsillectomy. 2 Parents are generally dissatisfied with the management of postoperative pain and nausea, and the majority of our participants sought additional information from either their local pharmacy or general practitioner post-discharge. 3 Enhanced parental pre-operative education focusing on pain management may benefit children's outcomes.Tonsillectomy, with and without adenoidectomy, is a frequently performed surgical procedure for children world-wide. 1,2 Tonsillectomies are mainly performed for the treatment of adenotonsillar hypertrophy (resulting in sleep-disordered breathing) and recurrent tonsillitis. 1,3 However, despite its safe reputation, tonsillectomies are associated with significant risk of morbidity and delays to recovery. 2,4,5 Post-operative complications include bleeding, respiratory compromise, infection, dehydration, pain,...

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Predictors of Complications of Tonsillectomy With or Without Adenoidectomy in Hospitalized Children and Adolescents in the United States, 2001-2010

Cited by 38 publications

References 39 publications

Self-Reported Complications after Tonsillectomy: Comparison of Responders and Nonresponders to a Mailed Questionnaire

Self-Reported Complications after Tonsillectomy: Comparison of Responders and Nonresponders to a Mailed Questionnaire

Risk Factors for Multiple Hemorrhages Following Tonsil Surgery in Children

Impact of paediatric tonsillectomy perioperative management on pain, nausea and recovery: A prospective cohort study

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