COMMENTARY

Outpatient Tonsillectomy: Who to Watch

William T. Basco, Jr, MD, MS

Disclosures

June 03, 2015

A Population-Based Study of Acute Care Revisits Following Tonsillectomy

Edmonson MB, Eickhoff JC, Zhang C
J Pediatr. 2015;166:607-612

Study Summary

Minimal population-based data are available to indicate the frequency of unexpected or unplanned repeat visits after tonsillectomy in children. Previous case series or cohort studies have helped to define postsurgical visits and types, but this study was able to analyze the reasons for such visits on a population basis.

The investigators used data from the Healthcare Cost and Utilization Project (HCUP) merged with California hospital, ambulatory surgery, and emergency department utilization data to describe revisits after tonsillectomy—especially the timing of these visits—to estimate revisit rates in the month after surgery and to perform analyses to identify factors associated with repeat visits.

The patients were all aged 0-24 years and had undergone tonsillectomy (with or without adenoidectomy) between 2009 and 2011. Patients who had tonsillectomy as a result of cancer were excluded. The main outcomes were all revisits, revisits related to bleeding, and hospital readmissions within 30 days after the index procedure.

The analysis was stratified by 5-year age groups as well as by sex. Multivariable analyses also included race/ethnicity, expected payer, number of chronic conditions, type of procedure initially performed (with or without adenoidectomy), and type of surgical facility.

The data set contained more than 35,000 tonsillectomies, 40% of which were performed in children aged 5-9 years and 24% in children aged 0-4 years. Although the sex distribution was even overall, younger patients with tonsillectomy tended to be female; males predominated among the older age groups. Race and ethnicity were reasonably distributed, as was the insurance coverage of the patients. At least one chronic condition was coded in 48.8% of the patients, and 32.8% had two or more chronic conditions.

More than 75% of the procedures were tonsillectomy with adenoidectomy, and the remainder were tonsillectomy alone. Infection was the reason for 41% of the procedures, and 38.7% were performed to correct sleep disturbances or apnea.

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