1. Among children undergoing tonsillectomy, the rate of postoperative death was 7 per 100 000 operations overall.

2. In children with complex chronic conditions, the rate of postoperative death was 117 per 100 000 operations.

Evidence Rating Level: 2 (Good)

Study Rundown: Tonsillectomy is a safe and relatively common surgical procedure in children with sleep-disordered breathing and recurrent infections refractory to conservative medical management. However, there is limited data on the rate of postoperative death in children undergoing tonsillectomy, particularly among children at increased risk of complications, including young children and those with sleep-disordered breathing or complex chronic conditions. This retrospective cohort study assessed overall postoperative mortality rates in children undergoing tonsillectomy and in those with recognized risk factors for complications from 5 US states. Key outcomes included postoperative death within 30 days or during a surgical stay lasting more than 30 days assessed using modified Poisson regression. Among 504 262 children undergoing tonsillectomy, the rate of postoperative death was 7 per 100 000 operations overall. In children with complex chronic conditions, the rate of postoperative death was 117 per 100 000 operations (44% of all postoperative deaths). A limitation of this study was that due to the relatively low absolute number of related deaths, statistical analysis of potential interactions between covariates on mortality risk was precluded or could not be performed accurately.

Click to read the study in JAMA

Click to read an accompanying editorial in JAMA

Relevant Reading: Postoperative complications in pediatric tonsillectomy and adenoidectomy in ambulatory vs inpatient settings

In-Depth [retrospective cohort]: This cohort study included 504 262 children (median [IQR] age, 7 [4-12] years; 50.6% females), who underwent a total of 505 182 tonsillectomies (10.1% young children, 28.9% with sleep-disordered breathing, 2.8% with complex chronic conditions) from 5 US states between 2005-2017. Overall, there were 36 related postoperative deaths, most of which occurred after surgical discharge (53%) and a median of 4.5 days after surgical admission. The unadjusted mortality rate was 7.04 (95%CI, 4.97-9.98) deaths per 100 000 operations. Multivariable analysis revealed that children with complex chronic conditions, particularly in children with neurologic or congenital disorders, had significantly higher mortality (16 death/14 299 operations; 44% of postoperative deaths) than children without these conditions (20 deaths/490 883 operations) (117.22 vs 3.87 deaths per 100 000 operations; adjusted rate difference, 113.55 [95%CI, 51.45-175.64] deaths per 100 000 operations; adjusted rate ratio, 29.39 [95%CI, 13.37-64.62]).

Image: PD

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