Adult Tonsillectomy Shown to be Safe, With Few Complications

Tonsillectomy in adults is a safe procedure, showing low rates of mortality and complications, according to new research published online January 30 in JAMA Otolaryngology–Head & Neck Surgery.

"Adult patients who undergo tonsillectomy in the United States have a low risk of reoperation and mortality similar to that in the pediatric population," the authors write.

Although there is ample evidence of pediatric tonsillectomy safety, research on adult tonsillectomy is lacking. Tonsillectomy is one of the most common surgeries, according to the authors, with 297,000 tonsillectomies performed in 2006 in patients older than 15 years. This new study is believed to be the first population-level study on adult tonsillectomy.

For the retrospective study, Michelle M. Chen, BA, from the Yale University School of Medicine, New Haven, Connecticut, and colleagues evaluated data on 5968 adult patients included in the database of the American College of Surgeons National Surgical Quality Improvement Program. All patients underwent tonsillectomy between 2005 and 2011.

The 30-day mortality rate among the patients was 0.03%, and the rate of complications was 1.2%. The reoperation rate was 3.2%, which is slightly higher than the reoperation rate reported in the pediatric literature, which ranges from 0.5% to 2.1%.

The most common indications for surgery were chronic tonsillitis and/or adenoiditis (82.9%). Infections were the most common postoperative complication, with pneumonia the most common infection (27%), followed by urinary tract infection (27%) and superficial site infections (16%).

Although twice as many women as men underwent tonsillectomy in the cohort, the strongest risk factor associated with reoperation was being male (54.0% of those who had a reoperation vs 32.4% of those who did not; P < .001). Other risk factors included being white (84.8% vs 75.3%; P = .02), being an inpatient (24.3% vs 14.3%; P < .001), and having postoperative complications (5.3% vs 1.1%; P < .001).

Further multivariate analysis showed that independent risk factors for reoperation included male sex (odds ratio [OR], 2.30; 95% confidence interval [CI], 1.67 - 3.15), inpatient status (OR, 1.52; 95% CI, 1.04 - 2.22), and the presence of a postoperative complication (OR, 4.58; 95% CI, 2.11 - 9.93).

The overall rate of substantial bleeding in the cohort was 0.08%, and there was no association between sex and substantial postoperative bleeding, the authors note.

"Our data indicate that adult tonsillectomy in the United States is a safe procedure; however, additional research into the prevention of postoperative infection in high-risk patients may be useful in continuing to reduce reoperation rates," the authors write.

The research was supported by the James G. Hirsch, MD, Endowed Medical Student Research Fellowship at Yale University School of Medicine. The authors have disclosed no relevant financial relationships.

JAMA Otolaryngol Head Neck Surg. Published online January 30, 2014. Abstract

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