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Very young children at increased risk for post-tonsillectomy complications
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Healthy children aged younger than 3 years were at increased risk for post-tonsillectomy complications vs. children aged 3 to 6 years, according to findings recently published in JAMA Otolaryngology Head and Neck Surgery.
“To date, the data on the safety of outpatient tonsillectomy in children under age 3 years is mixed,” Claire Lawlor, MD, of the department of pediatric otolaryngology at Boston Children’s Hospital, told Healio Family Medicine. “Some studies demonstrate children under age 3 years are at increased risk for complications after tonsillectomy when compared to children over age 3 years, whereas some studies show the risks are the same regardless of age.”
“For this reason, there is variation in clinical practice among surgeons across the country with regard to the postoperative management of this younger age group,” she added.
Researchers reviewed records of 1,817 children (mean age at tonsillectomy, 46 months; mean weight, 17 kg) who did not have moderate-to-severe developmental delay, bleeding disorders or other major medical comorbidities.
“Our thought was weight, in addition to age, could help surgeons determine which young children were safe for outpatient surgery and which should be admitted overnight,” Lawlor explained.
Researchers found that 7% of the 455 children aged younger than 3 years had complications vs. 4.6% of the 1,362 patients aged older than 3 years. The odds of children aged younger than 3 years having a complication was greater than it was in older children (OR = 1.56; 95% CI, 1-2.42). In addition, children in the younger age group were more likely to have a complication within the first 24 hours after surgery than their older counterparts (OR = 3.17; 95% CI, 1-10.11).
Also, regardless of child’s age, those admitted to the hospital had a greater risk for complication than outpatients (OR = 3.49; 95% CI, 2.02-6.05). There was no link between weight and complications.
“Our study represents the largest review of healthy children under age 6 years undergoing tonsillectomy and suggests children under age 3 years may indeed be at increased risk of post-tonsillectomy complications,” Lawlor said in the interview. “Based on these results, we suggest children under age 3 years that undergo tonsillectomy be considered for overnight observation after tonsillectomy rather than scheduled as an outpatient procedure.”
Complications following tonsillectomy included primary and secondary hemorrhage, desaturations requiring supplemental oxygen, stertor and stridor, post-obstructive pulmonary edema, dehydration and respiratory compromise related to obstructive sleep apnea, according to researchers. – by Janel Miller
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Donald Solomon, MD
Lawlor and colleagues’ article confirms the postoperative care paradigm utilized at Cooper University Health Care.
It has long been known that children aged younger than 3 years undergoing tonsillectomy are at higher risk for immediate postoperative complications, including dehydration or respiratory event, and hence benefit from a 24-hour observation in the hospital following surgery. Here at Cooper, we take postoperative management of our young tonsillectomy patients very seriously and go a step further than even the consensus guidelines recommend and admit all our pediatric tonsillectomy patients with a history of obstructive sleep apnea no matter their age, including up to the teenage years. We also admit all our postoperative tonsillectomy patients aged younger than 3 years as the guidelines recommend.
Following tonsillectomy surgery almost all patients complain of significant discomfort, and the paradigm of admitting our youngest postoperative tonsillectomy patients, which was confirmed by this recent study, as well as the further step we take at Cooper of admitting all our tonsillectomy patients with a history of obstructive sleep apnea, adds the extra layer of protection and vigilant care our patients expect and deserve.
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