title: Pediatric adenoidectomy: what is the effect of obstructive symptoms on the likelihood of future surgery?
abstract: OBJECTIVE
  Determine if pediatric patients undergoing adenoidectomy for obstruction have an increased likelihood of undergoing eventual tonsillectomy and/or second adenoidectomy over extended follow-up.
  
  
  METHODS
  Retrospective cohort study within the ambulatory surgery component of a tertiary children's hospital. Exclusion criteria consisted of the presence of significant co-morbid conditions (obesity, craniofacial syndrome, cerebral palsy, etc.) and less than 1 year of post-adenoidectomy follow-up. The study population included 100 children (mean age=3.9 years, range 0.9-15 years) randomly selected from a financial billing database undergoing adenoidectomy either with pre-operative obstructive symptoms (OB n=52) or without pre-operative obstructive symptoms (NOB n=48) with a minimum of 1 year of retrospective follow-up. Electronic records were searched for subsequent surgery (tonsillectomy and/or revision adenoidectomy).
  
  
  RESULTS
  Overall, 29 of 100 children (29%) underwent subsequent surgery (tonsillectomy and/or revision adenoidectomy) over an average of 3.46 years (range 1.0-6.59 years) retrospective follow-up. Children in the OB group were three times more likely (age, sex adjusted odds ratio=3.03, 95% confidence interval =1.18-7.78 p=0.021) than children in the NOB group to require tonsillectomy or second adenoidectomy. Age less than 2 years at time of initial adenoidectomy also suggested an increased likelihood of subsequent surgery.
  
  
  CONCLUSIONS
  Children undergoing adenoidectomy with obstructive symptoms are more likely to require eventual tonsillectomy and/or second adenoidectomy than those undergoing adenoidectomy without obstruction. However, the low absolute likelihood of future surgery precludes a generalized recommendation for tonsillectomy in these children.
authors.affiliation: Otolaryngology-Head and Neck Surgery Service, Walter Reed Army Medical Center, Department of Otolaryngology, Washington, DC 20307, USA. sebrietzke@msn.com
authors.forename: Scott E
authors.initials: SE
authors.lastname: Brietzke
authors.forename: Margaret
authors.initials: M
authors.lastname: Kenna
authors.forename: Eliot S
authors.initials: ES
authors.lastname: Katz
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Mitchell
authors.forename: David
authors.initials: D
authors.lastname: Roberson
mesh_terms: D000233:Adenoidectomy; D000293:Adolescent; D000402:Airway Obstruction / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D016013:Likelihood Functions; D008297:Male; D010033:Otitis Media / Q000601:surgery; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014068:Tonsillectomy / Q000706:statistics & numerical data*