Trends in postoperative complications following pediatric tonsillectomy & adenoidectomy: A 10-year analysis

Ogechukwu S Anwaegbu; Delaney E S Clark; Samsudeen O Iyamah; Chikobi Ezenwukwa; Ugonne L Etufugh; Brian J McKinnon

doi:10.1016/j.amjoto.2025.104712

Trends in postoperative complications following pediatric tonsillectomy & adenoidectomy: A 10-year analysis

Am J Otolaryngol. 2025 Sep-Oct;46(5):104712. doi: 10.1016/j.amjoto.2025.104712. Epub 2025 Jul 22.

Authors

Ogechukwu S Anwaegbu¹, Delaney E S Clark², Samsudeen O Iyamah², Chikobi Ezenwukwa², Ugonne L Etufugh², Brian J McKinnon³

Affiliations

¹ John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX 77554, USA. Electronic address: oganwaeg@utmb.edu.
² John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX 77554, USA.
³ Department of Otolaryngology, The University of Texas Medical Branch, Galveston, TX 77554, USA.

PMID: 40752357
DOI: 10.1016/j.amjoto.2025.104712

Abstract

Objective: Assess the rates of post-operative complications following tonsillectomy with/without adenoidectomy over a 10-year span, comparing young children and adolescents, while examining the influence of comorbidities, social determinants of health, and potential racial, and gender differences.

Methods: A retrospective cohort study using TriNetX database with de-identified electronic medical records from 57 healthcare organizations for ages 0-17 who had tonsillectomy with/without adenoidectomy from January 2014 to December 2023. Risk analysis and incidence proportion over a 10-year period for 5 outcomes occurring within 30 days, stratified by gender, race, and ethnicity. Then further subdivided into two groups: Early Childhood (0-9 years) and Adolescence (10-17 years). Statistical analysis included risk ratios (RR), and 95 confidence intervals (CI), with statistical significance set at p ≤ 0.05.

Results: Before propensity score matching, 197,885 pediatric patients were identified. Most common complications occurring within 30 days were pain (3.1 %), post-operative hemorrhage (2.3 %) with 1.3 % requiring re-operation for control, dehydration (2.1 %), infection (0.26 %), and acute respiratory complications (0.21 %). Before propensity score matching, Early Childhood cohort (0-9 years: n = 71,024) and Adolescence cohort (10-17 years: n = 126,861). After propensity matching, n = 56,036 for both groups. Early Childhood cohort had higher rates for potential health hazards related to socioeconomic and psychosocial circumstances (p = 0.013) and environmental tobacco smoke exposure-related risks (p = 0.016) than Adolescence cohort. No significant differences in complication risks were observed between the two pediatric age groups.

Conclusion: Rates of dehydration and acute respiratory distress have declined, while post-operative hemorrhage, and pain have been increasing, and observable racial differences continue to persist within these complications.

Level of evidence: III.

Keywords: Pediatric airway; Pediatric general; Pediatrics.

MeSH terms

Adenoidectomy* / adverse effects
Adolescent
Child
Child, Preschool
Female
Humans
Incidence
Infant
Infant, Newborn
Male
Postoperative Complications* / epidemiology
Postoperative Complications* / etiology
Retrospective Studies
Risk Factors
Tonsillectomy* / adverse effects