Tonsils or adenoids removal associated with the development of stress-related disorders: Study

A new study uncovered a concerning link between the surgical removal of tonsils or adenoids in early life and an increased risk of stress-related psychiatric disorders later in life. This study looked into the potential psychological repercussions of a common pediatric surgery which was published in Journal of American Medical Association.

The research analyzed data from Swedish nationwide population and health registries covered individuals born between 1981 and 2016. This  compared 2 groups where one had individuals who underwent tonsillectomy or adenoidectomy (exposed group) and other with those who did not (unexposed group). 

This population-matched cohort included a total of 83,957 exposed individuals and 839,570 unexposed counterparts, those who had the surgery exhibited a 43% higher risk of developing stress-related disorders. These included post-traumatic stress disorder (PTSD), acute stress reactions, and adjustment disorders. The hazard ratio (HR) for PTSD was even more pronounced at 1.55 which indicated a 55% increased risk when compared to unexposed individuals.

Also, in the sibling-matched cohort which consisting of 51,601 exposed individuals and 75,159 unexposed siblings, a 34% increased risk of stress-related disorders was observed which reinforced the findings from the larger cohort. PTSD risk in this cohort was also elevated (HR, 1.41).

The heightened risk was consistent across various demographic and clinical subgroups. Factors such as sex, age at surgery, time since surgery, parental educational attainment, and parental history of stress-related disorders did not significantly alter the results. The strongest association was seen in cases where surgery was performed due to adenotonsillar diseases or sleep and respiratory abnormalities.

This study highlights the need to explore the underlying mechanisms connecting early-life adenotonsillar conditions and their treatments to long-term mental health outcomes. It also raises questions about whether the stress of surgery or the health conditions prompting the procedure contribute to the observed risks.

While tonsillectomy and adenoidectomy are often necessary for managing severe medical conditions, the potential psychological effects should be factored into pre- and post-operative care by emphasizing the need for careful risk-benefit analyses and long-term monitoring of mental health outcomes in affected children.

Overall, this study opens the door for further investigation into the intersection of physical and mental health in pediatric populations by potentially reshaping how surgical interventions in children are approached.

Source:

Xiao, X., Yang, F., Yin, L., Isung, J., Ye, W., Mataix-Cols, D., Zhang, Z., Valdimarsdóttir, U., & Fang, F. (2024). Stress-Related Disorders Among Young Individuals With Surgical Removal of Tonsils or Adenoids. In JAMA Network Open (Vol. 7, Issue 12, p. e2449807). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2024.49807