Rate of Children Dying After a Tonsillectomy is 17 Times Higher Among Those With Complex Chronic Conditions: Study

Children with chronic conditions are substantially more likely to die after a tonsil removal, according to the findings of a new study that sought to identify what patient characteristics are associated with the greatest tonsillectomy mortality rates.

In findings published this week in the Journal of the American Medical Association (JAMA), researchers from the University of Wisconsin indicated the rate of post-operative tonsillectomy death was about 7 out of 100,000 operations overall. However, among children with complex chronic conditions, such as congenital birth defects or genetic disorders, the study identified a mortality rate of 117 children per 100,000 tonsil removal surgeries.

Researchers with the university’s School of Medicine and Public Health conducted a retrospective cohort study involving data on 504,000 children who underwent tonsillectomy in five states between 2005 and 2017, using state ambulatory, surgery, inpatient and emergency department discharge data records.

The rate of children dying after a tonsillectomy was 17 times higher among those with complex chronic conditions, including neurologic/neuromuscular or congenital/genetic disorders. Children with these complex chronic conditions accounted for 3% of all tonsillectomies, but accounted for 44% of all tonsil removal surgery deaths.

Tonsillectomy surgery is generally considered a safe procedure, but does include known risks for severe pain, dehydration, respiratory failure, and bleeding. These factors can lead to further complications, including rare cases of aspiration and postoperative death.

Researchers found that healthy children were more likely to die shortly after surgery if they suffered sudden, unforeseen respiratory events. Children with chronic complex conditions died after prolonged admissions, and more deaths occurred after initial same-day discharge.

Clinical guidelines recommend high-risk children undergo inpatient observation, but 64% of children with complex chronic conditions were discharged the same day. The researchers indicated that the findings may help inform better decision-making for pediatric tonsillectomy surgery.

An editorial published with the study highlighted underlying obstructive sleep apnea as a possible factor to increased risk of complications and postoperative death. Prior research has shown children with a history of obstructive sleep apnea were five times more likely to experience complications after tonsillectomy. Authors also point out that children with hypotonic neurologic disorders cannot be safely treated with positive pressure therapy and may need other treatment options.

Roughly 340,000 ambulatory and 10,000 inpatient tonsillectomies are performed every year. It is one of the most common pediatric surgical procedures. Researchers said the findings indicate a need for further policies and interventions to prevent future unnecessary deaths.