Postoperative mortality higher among kids with complex chronic conditions undergoing tonsillectomy: JAMA

Madison: A recent study has found that in children undergoing tonsillectomy, the rate of postoperative death was 117 per 100 000 operations among children with complex chronic conditions and 7 per 100 000 operations overall. The findings of the study, published in the Journal of the American Medical Association (JAMA) may inform decision-making for pediatric tonsillectomy.

There is uncertainty around the rate of postoperative death in children undergoing tonsillectomy. There is no separate availability for the mortality rates for children at increased rates of complications, including young children (aged <3 y) and those with complex chronic conditions or sleep-disordered breathing. 

Considering the above, M. Bruce Edmonson, University of Wisconsin School of Medicine and Public Health, Madison, and colleagues aimed to estimate postoperative mortality following tonsillectomy in US children, both overall and in relation to recognized risk factors for complications in a retrospective cohort study. 

The study was based on a longitudinal analysis of linked records in state ambulatory surgery, inpatient, and emergency department discharge data sets distributed by the Healthcare Cost and Utilization Project for 5 states covering 2005 to 2017. It included participants 504 262 persons younger than 21 years for whom discharge records were available to link outpatient or inpatient tonsillectomy with at least 90 days of follow-up. 

The main outcome and measures were postoperative death within 30 days or during a surgical stay lasting more than 30 days. To estimate postoperative mortality per 100 000 operations, both overall and in relation to age group, sleep-disordered breathing, and complex chronic conditions, modified Poisson regression with sample weighting was used.

A total of 505 182 tonsillectomies (median patient age, 7 years; 50.6% females) were performed on 504 262 children in the cohort, of which 10.1% were performed in young children, 28.9% in those with sleep-disordered breathing, and 2.8% in those with complex chronic conditions. 

The study led to the following findings:

There were 36 linked postoperative deaths, which occurred a
median (IQR) of 4.5 days after surgical admission, and most of which (19/36
[53%]) occurred after surgical discharge. The unadjusted mortality rate was 7.04 deaths per 100 000
operations. In multivariable models, neither age younger than 3 years nor
sleep-disordered breathing was 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 deaths per 100 000 operations; adjusted rate
ratio, 29.39). Children with complex chronic conditions accounted for 2.8% of
tonsillectomies but 44% of postoperative deaths. Most deaths associated with complex chronic conditions occurred
in children with neurologic/neuromuscular or congenital/genetic disorders.

“Among children undergoing tonsillectomy, the rate of postoperative death was 7 per 100 000 operations overall and 117 per 100 000 operations among children with complex chronic conditions,” the authors wrote in their conclusion.” “These findings may inform decision-making for pediatric tonsillectomy.”

Reference:

Edmonson MB, Zhao Q, Francis DO, et al. Association of Patient Characteristics With Postoperative Mortality in Children Undergoing Tonsillectomy in 5 US States. JAMA. 2022;327(23):2317–2325. doi:10.1001/jama.2022.8679

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