title: Mortality and major morbidity after tonsillectomy: etiologic factors and strategies for prevention.
abstract: OBJECTIVE
  To report data on death or permanent disability after tonsillectomy.
  
  
  METHODS
  Electronic mail survey.
  
  
  METHODS
  A 32-question survey was disseminated via the American Academy of Otolaryngology-Head and Neck Surgery electronic newsletter. Recipients were queried regarding adverse events after tonsillectomy, capturing demographic data, risk factors, and detailed descriptions. Events were classified using a hierarchical taxonomy.
  
  
  RESULTS
  A group of 552 respondents reported 51 instances of post-tonsillectomy mortality, and four instances of anoxic brain injury. These events occurred in 38 children (71%), 15 adults (25%), and two patients of unstated age (4%). The events were classified as related to medication (22%), pulmonary/cardiorespiratory factors (20%), hemorrhage (16%), perioperative events (7%), progression of underlying disease (5%), or unexplained (31%). Of unexplained events, all but one occurred outside the hospital. One or more comorbidities were identified in 58% of patients, most often neurologic impairment (24%), obesity (18%), or cardiopulmonary compromise (15%). A preoperative diagnosis of obstructive sleep apnea was not associated with increased risk of death or anoxic brain injury. Most events (55%) occurred within the first 2 postoperative days. Otolaryngologists who reported performing <200 tonsillectomies per year were more likely to report an event (P < .001).
  
  
  CONCLUSIONS
  This study, the largest collection of original reports of post-tonsillectomy mortality to date, found that events unrelated to bleeding accounted for a preponderance of deaths and anoxic brain injury. Further research is needed to establish best practices for patient admission, monitoring, and pain management.
  
  
  METHODS
  N/A.
authors.affiliation: Division of Otolaryngology, Department of Surgery, University of Louisville, Louisville, Kentucky.
authors.forename: Julie L
authors.initials: JL
authors.lastname: Goldman
authors.forename: Reginald F
authors.initials: RF
authors.lastname: Baugh
authors.forename: Louise
authors.initials: L
authors.lastname: Davies
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Skinner
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Stachler
authors.forename: Jean
authors.initials: J
authors.lastname: Brereton
authors.forename: Lee D
authors.initials: LD
authors.lastname: Eisenberg
authors.forename: David W
authors.initials: DW
authors.lastname: Roberson
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Brenner
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D006801:Humans; D002534:Hypoxia, Brain / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology; D014068:Tonsillectomy / Q000009:adverse effects; D055815:Young Adult
keywords: Tonsillectomy; clinical practice guideline; complications; hemorrhage; morbidity; mortality; obstructive sleep apnea; patient safety; quality; survey; tonsillitis