Children with developmental delay at higher risk of complications after tonsillectomy: Study

USA: Children with developmental delay (DD) had notably higher complication rates than those without, a recent study published in the International Journal of Pediatric Otorhinolaryngology has shown. 

Results showed that patients with DD had a significantly increased risk for postoperative complications and experienced significantly more respiratory complications, such as respiratory arrest and overnight oxygen desaturation. Where 32.14% of patients with DD had a complication after surgery, only 8.72% of patients without DD had a complication. Other complications included postoperative haemorrhage, dehydration and vomiting.

Furthermore, patients with moderate to severe DD had a higher risk for postoperative complications than those with mild DD. Patients with Down syndrome, Global Developmental Delay or two or more delays in developmental milestones were classified as severe. Nine out of 13 patients (69.23%) in the severe DD subgroup experienced complications after surgery.

Developmental delay (DD) refers to a broad group of conditions that involve impairments in communication, gross and fine motor skills, problem-solving and social interactions. Children with DD often have complex medical histories with comorbidities, increasing their need for more healthcare treatment than children without DD.

“We have a limited amount of literature studying the effect of DD in pediatric surgical patients,” said Sheyn. “We wanted to investigate DD's role in the outcome of our most performed pediatric surgery, tonsillectomy.”

Researchers reviewed chart data from 400 tonsillectomy patients to compare postoperative complication rates between children with and without DD. Of these patients, 56 (13.9%) had a DD diagnosis.

This study emphasizes the need for in-depth pre-operative planning for patients with DD to lower the risk of complications post-operation. Researchers suggest this need is heightened for patients with moderate to severe DD, but more research is needed to define DD severity and how it affects surgical outcomes.

“This elevated risk of complications should be included in pre-operative counselling and has potential implications for pre-operative decision-making and treatment plans in this high-risk population,” said Sheyn. “We suggest in-depth counselling and close follow-up after surgery for these patients to help reduce the current findings of an increased complication rate.”

Reference:

Jordan B. Luttrell, Chad A. Nieri, Madhu Mamidala, Anthony Sheyn, Outcomes and considerations in children with developmental delay undergoing tonsillectomy, International Journal of Pediatric Otorhinolaryngology, https://doi.org/10.1016/j.ijporl.2022.111393