For a study, researchers sought to assess postoperative mortality after tonsillectomy in children in the United States, both generally and in relation to known risk factors for complications.

The Healthcare Cost and Utilization Project provided state ambulatory surgical, inpatient, and emergency department discharge data sets for 5 states from 2005 to 2017. Participants were 504,262 people under the age of 21 who had discharge records linking outpatient or inpatient tonsillectomy to at least 90 days of follow-up. Death within 30 days of surgery or during a surgical stay of more than 30 days. Postoperative mortality per 100,000 procedures was estimated using modified Poisson regression with sample weighting, both generally and in relation to age group, sleep-disordered breathing, and complicated chronic diseases. 

The 504,262 children in the cohort had 505,182 tonsillectomies (median [IQR] patient age, 7 [4-12] years; 50.6% females), with 10.1% performed in young children, 28.9% performed in those with sleep-disordered breathing, and 2.8% performed in those with complex chronic conditions. There were 36 related postoperative fatalities that occurred 4.5 (2-20.5) days after surgical admission, with the majority of these (19/36 [53%]) occurring after surgical discharge. The unadjusted mortality rate per 100,000 surgeries was 7.04 (95% CI, 4.97-9.98). In multivariable models, neither age under 3 years nor sleep-disordered breathing were significantly associated with mortality, but children with complex chronic conditions had significantly higher mortality (16 deaths/14,299 operations) 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]). Children with chronic illnesses accounted for 2.8% of tonsillectomies but 44% of postoperative mortality. The majority of fatalities in children with complicated chronic diseases were caused by neurologic/neuromuscular or congenital/genetic abnormalities. 

The risk of postoperative mortality among children receiving tonsillectomy was 7 per 100,000 procedures overall and 117 per 100,000 operations among children with complicated chronic illnesses. These data might help guide paediatric tonsillectomy decisions.