Following a tonsillectomy, children under 3 years may be at greater risk for complications
than older children.
Researchers analyzed records of 1,817 patients 6 years or younger undergoing tonsillectomy
at six hospitals in Louisiana between 2005 and 2015. About 44.3% had surgery due to
sleep-disordered breathing, while 44.8% had an infectious indication.
After the procedure, roughly 7% of patients under 3 years had a complication, and
about 75% of those occurred late (more than 24 hours after surgery). Among patients
3 years and older, 4.6% had a complication, about 90% of which occurred late. The
later complications typically included hemorrhage and dehydration, while hemorrhage
and respiratory distress were seen earlier.
The complications did not appear to be linked to a child’s weight, but authors noted
this variable needs more study.
Children who were admitted to a hospital had 3.5 times greater odds of having a complication
compared to those who had an outpatient procedure, according to the study. Researchers
said the finding is a testament to clinicians’ judgment as to which children needed
to stay overnight, although many of the complications happened after the first night.
The American Academy of Otolaryngology-Head and Neck Surgery’s 1996 guidelines recommended
children younger than 3 years be admitted after tonsillectomy. However, in a 2011
update, those admission recommendations applied only to those with sleep-disordered
breathing. Authors said their new findings do not mean all healthy children under
3 years need to be admitted.
“… clinicians should continue to rely on their judgement when planning outpatient
tonsillectomies and assessing patients for discharge in the PACU (post-anesthesia
care unit),” they wrote.