title: Predictors of Complications of Tonsillectomy With or Without Adenoidectomy in Hospitalized Children and Adolescents in the United States, 2001-2010: A Population-Based Study.
abstract: Outcomes of tonsillectomy (with or without adenoidectomy [w/woA]) in hospitalized children are unclear. We sought, to describe the characteristics of hospitalized children who underwent tonsillectomy (w/woA), to estimate the prevalence of complications and to evaluate the relative impact of different comorbid conditions (CMC) on the risk of occurrence of common complications following these procedures. All patients aged ≤21years who underwent a tonsillectomy (w/woA) were selected from the Nationwide Inpatient Sample (NIS 2001-2010). The associations between several patient/hospital-level factors and occurrence of complications were generated using multivariable logistic regression models. Over a decade, a total of 141 599 hospitalized patients underwent tonsillectomy (w116 319; woA 25 280). A total of 58.1% were males. Majority of the procedures were performed in teaching hospitals (TH, 73.7%), in large (bed-size) hospitals (LH, 57.8%), and in those who were electively admitted (EA, 67.3%). Frequently present CMC in patients included obstructive sleep apnea (OSA, 26.4%), chronic pulmonary disease (CPD, 14.6%), neurological disorders (ND, 6.7%), and obesity (4.8%). Majority of patients were discharged routinely (98%). Overall complication rate was 6.4% with common complications being postoperative pneumonia (2.3%), bacterial infections (1.4%), respiratory complications (1.3%), and hemorrhage (1.2%). All-cause mortality included a total of 60 patients. Patients in TH (odds ratio [OR] = 0.72, 95%CI = 0.62-0.85), LH (OR = 0.80, 95% CI = 0.69-0.93), and those who had the procedures during EA (OR = 0.64, 95% CI = 0.56-0.74) had significantly lower odds of complications compared with their counterparts. CMC such as anemia, CPD, coagulopathy, HT, ND, and fluid/electrolyte disorders were independent predictors of significantly higher complication risk (P < .05). In conclusion, hospitalized children who underwent tonsillectomy (w/woA) in large or teaching hospitals, or during elective admissions had lower risk of complications. Comorbidity is an important independent predictor of complications in this cohort.
authors.affiliation: Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, USA veerajalandhar.allareddy@uhhospitals.org.
authors.forename: Veerajalandhar
authors.initials: V
authors.lastname: Allareddy
authors.affiliation: Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Natalia
authors.initials: N
authors.lastname: Martinez-Schlurmann
authors.affiliation: University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Sankeerth
authors.initials: S
authors.lastname: Rampa
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.
authors.forename: Romesh P
authors.initials: RP
authors.lastname: Nalliah
authors.affiliation: Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Karen B
authors.initials: KB
authors.lastname: Lidsky
authors.affiliation: College of Dentistry-The University of Iowa, Iowa City, IA, USA.
authors.forename: Veerasathpurush
authors.initials: V
authors.lastname: Allareddy
authors.affiliation: Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Alexandre T
authors.initials: AT
authors.lastname: Rotta
mesh_terms: D000233:Adenoidectomy / Q000009:adverse effects*; D000293:Adolescent; D000328:Adult; D002648:Child; D002673:Child, Hospitalized / Q000706:statistics & numerical data; D002675:Child, Preschool; D002908:Chronic Disease; D015897:Comorbidity; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009422:Nervous System Diseases / Q000453:epidemiology*; D009765:Obesity / Q000453:epidemiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D012140:Respiratory Tract Diseases / Q000453:epidemiology*; D012189:Retrospective Studies; D014068:Tonsillectomy / Q000009:adverse effects*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: adenoidectomy; comorbidity; complications; hospitalization; tonsillectomy