Adenotonsillectomy and adenoidectomy in children: The impact of timing of surgery and post‐operative outcomes

Abstract

Aim: To investigate the impact of adenotonsillectomy (ADT) and adenoidectomy (AD) on child health and evaluated their post-operative complications. Methods: We included all children aged <16 years undergoing ADT (tonsillectomy AE adenoidectomy) or AD in New South Wales, Australia, 2008-2017. Health information was obtained from administrative hospitalisation data. Rates of post-operative complications and reoperation were evaluated using generalised estimating equations and Kaplan-Meier methods, respectively. Results: Out of 156 500 included children, 112 361 had ADT and 44 139 had AD. Population rates increased during 2008-2017 (ADT: 68-79 per 10 000 children; AD: 25-34 per 10 000), and children were increasingly operated on at a younger age. Overall, 7262 (6.5%) and 1276 (2.9%) children had post-operative complications (mostly haemorrhage), and 4320 (3.8%) and 5394 (12.2%) required reoperation, following ADT and AD, respectively. Complication rates were highest among children aged 0-1 years, lowest for those 2-5 years and increased with age thereafter. Three-year reoperation rates for children aged 0-1 years were 9.0% and 25.9% following ADT and AD, respectively, decreasing thereafter to 0.5% and 2.1% in children aged 12-13 years. Conclusions: ADT and AD in Australian children have both increased in frequency and are being done at a younger age. Post-operative complications and reoperation rates highlight surgery is not without risk, especially for children under 2 years old. These findings support a more conservative approach to management of upper respiratory symptoms, with surgery reserved for cases where potential benefits are most likely to outweigh harms.

Clinical Manifestations of Patients with Adenoid and Adenotonsillar Hypertrophy at Universitas Airlangga Hospital 2016-2021

“…Other countries such as Scotland and Australia have reported an increase in the rates of adenotonsillectomy and adenoidectomy among younger children. One main cause of the rise in adenotonsillectomy has been identified as the increased number of young children identified and treated for OSA or other less severe respiratory problems (Schneuer et al, 2022). Based on this study, it was found that 4 out of 7 patients (57.1%) with adenoid hypertrophy and 21 out of 31 patients (67.7%) with adenotonsillar hypertrophy experienced OSA.…”

“…Respiratory disturbances encompass various conditions ranging from snoring to the most severe form of OSA. Obstructive sleep apnea or OSA is characterized by irregular breathing and sleep patterns that can be observed during nighttime polysomnography (Schneuer et al, 2022).…”

“…The increased use of adenotonsillectomy as a first-line treatment may be influenced by concerns of physicians and parents about the potential long-term impacts on cardiovascular, cognitive, behavioral, and developmental effects of OSA in children. Adenoidectomy can be performed for OSA as long as the tonsils are not enlarged (Schneuer et al, 2022).…”

Pediatric Sleep Questionnaire for Sleep Apnea in Newly Diagnosed Adolescent Idiopathic Scoliosis Patients

“…In the year 2010, a US study reported the adenotonsillectomy rate as 0.68%, whereas this rate was indicated to be 1.2% in a 2016 Swedish study [ 32 ]. In another study, based on data from 2017, the adenotonsillectomy prevalence was reported as 0.70% [ 33 ]. In this study, 20.3% of all patients were diagnosed with adenoid and/or tonsil hypertrophy, a similar percentage to the study reporting an adenoid hypertrophy rate of 19.8% and a tonsil hypertrophy rate of 16.2% in patients with SDB [ 23 ].…”