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June 21, 2022

Mortality After Pediatric Tonsillectomy—Does the “D” Word Have a Place in Tonsillectomy Discussions?

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, University of Michigan, Ann Arbor
  • 2Department of Otolaryngology–Head and Neck Surgery, Eastern Virginia Medical School, Norfolk
  • 3Department of Pediatric Sleep Medicine, Children’s Hospital of the King’s Daughters, Norfolk, Virginia
  • 4Deputy Editor, JAMA Otolaryngology–Head & Neck Surgery
JAMA Otolaryngol Head Neck Surg. 2022;148(8):717-718. doi:10.1001/jamaoto.2022.1803

Tonsillectomy is one of the most common surgeries performed in children. In recent years, sleep-disordered breathing has replaced chronic tonsillitis as the most common indication for tonsillectomy in children. While tonsil surgery is safe and effective at relieving upper airway obstruction in most children, it can result in serious complications such as posttonsillectomy hemorrhage and respiratory compromise. Rarely, mortality can occur. Rates of mortality related to pediatric tonsillectomy, reported at 1 in 55 000,1 have been estimated from various sources including physician survey, malpractice claims, and database reviews. In the study published in JAMA, “Association of Patient Characteristics With Postoperative Mortality in Children Undergoing Tonsillectomy in 5 US States,”2 Edmonson et al aimed to identify clinical predictors of posttonsillectomy mortality from the Healthcare Cost and Utilization Project for patients younger than 21 years in 5 US states from 2005 to 2017. The authors report the overall mortality at 7 deaths per 100 000 tonsillectomies, which—while rare—is over twice the reported aggregate mortality for the 10 most common pediatric surgeries.

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