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 Researchers examined data on 1,817 children, ages one to six, who
had tonsillectomies at hospitals in New Orleans, Louisiana, between
2005 and 2015. Overall, 95 patients, or 5.2 percent, had
postoperative complications like bleeding, breathing difficulties or
dehydration.
Kids under three were 50 percent more likely to have complications
than older children, the study found.
"Based on these results, we suggest children under age 3 years
undergoing tonsillectomy be considered for overnight observation
after tonsillectomy rather than scheduled as an outpatient
procedure," said lead study author Dr. Claire Lawlor, a researcher
at Boston Children's Hospital and Harvard Medical School.
Tonsillitis is an inflammation of the tonsils that makes it
difficult for some kids to breathe or sleep. While it sometimes
clears up on its own, doctors may recommend surgery for children who
have several infections a year that contribute to breathing or
sleeping problems or cause kids to miss a lot of school.
"For children of all ages, including those under age 3 years,
tonsillectomy is sometimes a necessary procedure," Lawlor said by
email. "In such children the risks of the airway obstruction for
which the surgery is performed outweigh the risks of the surgery."
Even though medical guidelines recommend hospital admissions after a
tonsillectomy for children under three as well as for underweight
kids and children with breathing disorders, many of these patients
still get outpatient procedures and are sent home afterwards instead
of being admitted to the hospital, researchers note in JAMA
Otolaryngology Head & Neck Surgery. Hospital admission rates vary
widely across facilities and by patient age and other health
problems, ranging from five to 90 percent of cases.
The current study included 455 children under age three as well as
1,362 patients three and older. Most had outpatient procedures.
Thirty-two kids under three, or 7 percent, had complications,
compared with 63 kids, or 4.6 percent, among older children in the
study.
In the younger kids, 25 percent of complications occurred within the
first 24 hours after surgery, compared to 9.5 percent of
complications in the older children.
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Kids' weight, however, didn't appear to influence the risk of
complications.
The study wasn't a controlled experiment designed to prove whether
or how kids' age might influence their risk of complications after a
tonsillectomy. It's also possible that kids who were admitted to a
hospital were sicker than kids who had outpatient procedures.
It's also possible that the study was too small to detect meaningful
differences in outcomes based on how much kids weighed, said Dr.
Paul Hong of Dalhousie University in Halifax, Nova Scotia.
"However, it is fairly common for surgeons, including myself, to
think that age does matter," Hong, who wasn't involved in the study,
said by email.
Age is most likely strongly linked to the size of the child, noted
Dr. Neil Bhattacharyya, a researcher at Harvard Medical School and
Brigham and Women's Hospital in Boston who wasn't involved in the
study.
"You can imagine that in a very young child, even though you take
out the tonsils which may be causing obstruction as the indication
for the tonsillectomy, there can be postoperative airway swelling
and since the child is very young and therefore has a smaller
airway, this puts them at greater risk for an airway complication
such as airway obstruction or respiratory distress," Bhattacharyya
said by email.
"The data are somewhat compelling to advocate for most if not all
children under age three who undergo tonsillectomy to be admitted
for an overnight observation hospital stay," Bhattacharyya added.
SOURCE: http://bit.ly/2JqTJcP JAMA Otolaryngology Head & Neck
Surgery, online March 15, 2018.
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