4.2 Article

Adenotonsillectomy and adenoidectomy in children: The impact of timing of surgery and post-operative outcomes

期刊

JOURNAL OF PAEDIATRICS AND CHILD HEALTH
卷 58, 期 9, 页码 1608-1615

出版社

WILEY
DOI: 10.1111/jpc.16052

关键词

adenoidectomy; adenotonsillectomy; Australia; population health; post-operative; surgery

资金

  1. National Health and Medical Research Investigator Grant [1174523]
  2. National Health and Medical Research Council (NHMRC) grant

向作者/读者索取更多资源

This study aimed to investigate the impact of adenotonsillectomy (ADT) and adenoidectomy (AD) on child health and evaluated their post-operative complications. The results showed that the frequency of these surgeries in Australian children is increasing, and they are being done at a younger age. The rates of post-operative complications and reoperation highlight the risks associated with these surgeries, especially for children under 2 years old.
Aim To investigate the impact of adenotonsillectomy (ADT) and adenoidectomy (AD) on child health and evaluated their post-operative complications. Methods We included all children aged <16 years undergoing ADT (tonsillectomy +/- adenoidectomy) or AD in New South Wales, Australia, 2008-2017. Health information was obtained from administrative hospitalisation data. Rates of post-operative complications and reoperation were evaluated using generalised estimating equations and Kaplan-Meier methods, respectively. Results Out of 156 500 included children, 112 361 had ADT and 44 139 had AD. Population rates increased during 2008-2017 (ADT: 68-79 per 10 000 children; AD: 25-34 per 10 000), and children were increasingly operated on at a younger age. Overall, 7262 (6.5%) and 1276 (2.9%) children had post-operative complications (mostly haemorrhage), and 4320 (3.8%) and 5394 (12.2%) required reoperation, following ADT and AD, respectively. Complication rates were highest among children aged 0-1 years, lowest for those 2-5 years and increased with age thereafter. Three-year reoperation rates for children aged 0-1 years were 9.0% and 25.9% following ADT and AD, respectively, decreasing thereafter to 0.5% and 2.1% in children aged 12-13 years. Conclusions ADT and AD in Australian children have both increased in frequency and are being done at a younger age. Post-operative complications and reoperation rates highlight surgery is not without risk, especially for children under 2 years old. These findings support a more conservative approach to management of upper respiratory symptoms, with surgery reserved for cases where potential benefits are most likely to outweigh harms.

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