Detection of Respiratory Pathogens Does Not Predict Risks After Outpatient Adenotonsillectomy

Laryngoscope. 2021 Jun;131(6):E2074-E2079. doi: 10.1002/lary.29236. Epub 2020 Nov 5.


Objectives/hypothesis: To determine whether the presence of detectable upper respiratory infections (URIs) at the time of adenoidectomy/adenotonsillectomy is associated with increased morbidity, complications, and unexpected admissions.

Study design: Prospective double-blinded cohort.

Methods: In this prospective cohort study, nasopharyngeal swabs were obtained intraoperatively from 164 pediatric patients undergoing outpatient adenoidectomy/tonsillectomy with or without pressure equalization tubes (PETs) and were analyzed with PCR for the presence of 22 known URIs, including SARS-CoV-2. Surgeons and families were blinded to the results. At the conclusion of the study, rates of detectable infection were determined and intraoperative and postoperative events (unexpected admissions, length of PACU stay, rates of laryngospasm/bronchospasm, oxygen desaturation, bradycardia, and postoperative presentation to an emergency department) were compared between infected and uninfected patients.

Results: Of the 164 patients (50% male, 50% female, ages 8 mo-18 y), 136 patients (82.9%) tested positive for one or more URI at the time of surgery. Forty one patients (25.0%) tested positive for three or more URIs concurrently, and 11 (6.7%) tested positive for five or more URIs concurrently. There were no significant differences in admission rates, length of PACU stay, rates of laryngospasm/bronchospasm, oxygen desaturation, bradycardia, or postoperative presentation to an emergency department between positive and negative patients. No patients tested positive for SARS-CoV-2.

Conclusions: A recent positive URI test does not confer any additional intraoperative or postoperative risk in the setting of outpatient adenoidectomy/tonsillectomy in healthy patients. There is no utility in preoperative URI testing, and delaying surgery due to a recent positive URI test is not warranted in this population.

Level of evidence: 3 Laryngoscope, 131:E2074-E2079, 2021.

Keywords: Upper respiratory pathogen testing; adenoidectomy; outpatient surgery; tonsillectomy.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adenoidectomy*
  • Adolescent
  • Air Microbiology*
  • Ambulatory Surgical Procedures*
  • Child
  • Child, Preschool
  • Cohort Studies
  • Double-Blind Method
  • Female
  • Humans
  • Infant
  • Male
  • Nasopharynx / microbiology
  • Prospective Studies
  • Respiratory Tract Infections / microbiology*
  • Risk
  • Risk Factors
  • Surgical Wound Infection / microbiology*
  • Tonsillectomy*