Tonsillectomy has low mortality and morbidity in adults

By Rob Goodier

NEW YORK (Reuters Health) - Tonsillectomy is "very safe" in adults, with low mortality and morbidity rates, a new study has found.

The mortality rate in adults was 0.03% and the complication and reoperation rates were 1.2% and 3.2%, respectively, researchers reported online January 30 in JAMA Otolaryngology-Head and Neck Surgery. Infections accounted for the majority of complications.

In comparison, past studies suggest the pediatric mortality rate with tonsillectomy is 0.005% and the reoperation rate is 0.5% to 2.1%.

"The results of this study, analyzing a large number of patients, show that tonsillectomy in adults, particularly healthy adults, is very safe," coauthor Dr. Benjamin Judson of Yale University School of Medicine in New Haven, Connecticut, told Reuters Health.

He and his team analyzed records from the American College of Surgeons National Surgical Quality Improvement Program of 5968 adults who underwent tonsillectomy between 2005 and 2011.

Of those patients, 82.9% had a primary diagnosis of chronic tonsillitis, adenoiditis, or both.

Infections accounted for 58% of the 30-day complication rate. Among them, pneumonia and urinary tract infections were the most common, each accounting for 27% of all complications.

"Although any complication after tonsillectomy is uncommon, one unexpected finding from our study is the frequency with which pneumonia occurs," Dr. Judson said.

Surgical site complications also accounted for 27% of complications.

At 0.03%, the 30-day mortality rate for adults is almost ten-fold higher than it is for children, noted Dr. Glenn Isaacson, a pediatric otolaryngologist at Temple University School of Medicine in Philadelphia, Pennsylvania, who was not involved in the new research.

The patients included in this study may explain some of that difference.

"The selection of hospitalized patients, who make up a minority of tonsillectomy patients and have greater co-morbidities (10% ASA >3), may have accounted for the relatively high rate of death and complications in this series," Dr. Isaacson told Reuters Health.

In the current study, 14.3% of patients who did not require reoperation and 24.3% of those who had a repeat procedure were inpatients.

The takeaway, however, is that the risks of tonsillectomy are low for adults, Dr. Judson said.

SOURCE: http://bit.ly/1g7xaEk

JAMA Otolaryngol Head Neck Surg 2014.

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