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Toddlers should stay in the hospital after tonsillectomy

Toddlers should stay in the hospital after tonsillectomy
April 7, 2018
WASHINGTON (Reuters ) - Children who have their tonsils removed before they’re at least three years old may be more likely to have complications afterward than kids who have the surgery when they’re older, a US study suggests. Researchers examined data on 1,817 children, ages one to six, who had tonsillectomies at hospitals in New Orleans, Louisiana, between 2005 and 2015. Overall, 95 patients, or 5.2 percent, had postoperative complications like bleeding, breathing difficulties or dehydration. Kids under three were 50 percent more likely to have complications than older children, the study found. “Based on these results, we suggest children under age 3 years undergoing tonsillectomy be considered for overnight observation after tonsillectomy rather than scheduled as an outpatient procedure,” said lead study author Dr. Claire Lawlor, a researcher at Boston Children’s Hospital and Harvard Medical School. Tonsillitis is an inflammation of the tonsils that makes it difficult for some kids to breathe or sleep. While it sometimes clears up on its own, doctors may recommend surgery for children who have several infections a year that contribute to breathing or sleeping problems or cause kids to miss a lot of school. “For children of all ages, including those under age 3 years, tonsillectomy is sometimes a necessary procedure,” Lawlor said by email. “In such children the risks of the airway obstruction for which the surgery is performed outweigh the risks of the surgery.”
Even though medical guidelines recommend hospital admissions after a tonsillectomy for children under three as well as for underweight kids and children with breathing disorders, many of these patients still get outpatient procedures and are sent home afterwards instead of being admitted to the hospital, researchers note in JAMA Otolaryngology Head & Neck Surgery. Hospital admission rates vary widely across facilities and by patient age and other health problems, ranging from five to 90 percent of cases. The current study included 455 children under age three as well as 1,362 patients three and older. Most had outpatient procedures. Thirty-two kids under three, or 7 percent, had complications, compared with 63 kids, or 4.6 percent, among older children in the study. In the younger kids, 25 percent of complications occurred within the first 24 hours after surgery, compared to 9.5 percent of complications in the older children. Kids’ weight, however, didn’t appear to influence the risk of complications. The study wasn’t a controlled experiment designed to prove whether or how kids’ age might influence their risk of complications after a tonsillectomy. It’s also possible that kids who were admitted to a hospital were sicker than kids who had outpatient procedures. It’s also possible that the study was too small to detect meaningful differences in outcomes based on how much kids weighed, said Dr. Paul Hong of Dalhousie University in Halifax, Nova Scotia. “However, it is fairly common for surgeons, including myself, to think that age does matter,” Hong, who wasn’t involved in the study, said by email. Age is most likely strongly linked to the size of the child, noted Dr. Neil Bhattacharyya, a researcher at Harvard Medical School and Brigham and Women’s Hospital in Boston who wasn’t involved in the study. “You can imagine that in a very young child, even though you take out the tonsils which may be causing obstruction as the indication for the tonsillectomy, there can be postoperative airway swelling and since the child is very young and therefore has a smaller airway, this puts them at greater risk for an airway complication such as airway obstruction or respiratory distress,” Bhattacharyya said by email. “The data are somewhat compelling to advocate for most if not all children under age three who undergo tonsillectomy to be admitted for an overnight observation hospital stay,” Bhattacharyya added.