Postoperative mortality likely in children undergoing tonsillectomy?

The increasing rates of postoperative death in children under going tonsillectomy is uncertain. Mortality rates are not separately reported for children at increased risk of complications, including young children (aged <3 y) and those with sleep-disordered breathing or complex chronic conditions.

A recent retrospective cohort study published in JAMA Network included close to 5 lac Participants youngerthan21years for whom discharge records were available to link out patient or inpatient tonsillectomy with at least 90daysoffollow-up.

Postoperativedeathwas characterized as death within 30 days or during a surgical stay lasting more than 30 days. Out of the Total of 5 lac children, 10.1%tonsillectomies were performed in young children, 28.9%inthosewithsleep-disordered breathing, and 2.8%inthosewith complex chronic conditions. It was found that there were36postoperative deaths, which occurred in 4.5 day safter surgical admission, and most of which occurred after surgical discharge.

Additionally, neither those youngerthan3years nor sleep-disordered breathing was significantly associated with mortality, but children with complex chronic conditions had significantly higher mortality. Children with complex chronic conditions accounted for 2.8%oftonsillectomies but 44%of postoperative deaths. Most deaths associated with complex chronic conditions occurred in children with neurologic/neuromuscular or congenital/genetic disorders.

Therefore, the researchers concluded that among children under going tonsillectomy,the rate of postoperative death was7per100000operationsoveralland117per100000operations among children with complex chronic conditions. Hence, these findings may help practitioners in decision-making before performing pediatric tonsillectomy.

Reference: Edmonson MB, Zhao Q, Francis DO, et al. Association of Patient Characteristics With Postoperative Mortality in Children Undergoing Tonsillectomy in 5 US States. JAMA. 2022;327(23):2317–2325. doi:10.1001/jama.2022.8679.