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'Routine' tonsillectomies not so routine
January 20th, 2014
11:18 AM ET

'Routine' tonsillectomies not so routine

When Jahi McMath suffered severe complications following a tonsillectomy, and doctors declared her brain dead, many parents were shocked.

More than 500,000 tonsillectomies are performed each year on children in the United States; it's the second most common pediatric surgery. But how routine are these procedures really?

Not so much, a new study published Monday in the scientific journal Pediatrics suggests. Researchers found the quality of care before, during and after a tonsillectomy varies greatly depending on the hospital.

When routine surgeries go wrong

"We were surprised at the degree of variation between hospitals in the use of medications ... and revisits to hospitals after the surgery for complications," said lead study author Dr. Sanjay Mahant.

The study

Researchers analyzed data from the Pediatric Health Information System, looking specifically at 139,155 low-risk children who underwent tonsillectomies between 2004 and 2010 at 36 children's hospitals across the United States.

Guidelines from the American Academy of Otolaryngology-Head and Neck Surgery recommend doctors administer dexamethasone on the day of a tonsillectomy.  Dexamethasone is used to reduce nausea and pain after surgery. The guidelines do not recommend administering antibiotics because previous studies have shown that antibiotics do not help in preventing bleeding, pain or infection after a tonsillectomy.

In addition to looking at whether hospital staff followed these guidelines, Mahant and his team also calculated the number of patients who returned to the hospital in the 30 days after surgery for bleeding, vomiting/dehydration, pain, infection and/or respiratory problems.

The results

Close to 70% of patients received dexamethansone on the day of their surgery. Nearly a third received antibiotics.

A total of 10,868 children - about 7.8% - returned to the hospital after being discharged, most for bleeding and vomiting/dehydration. Those who came in with vomiting tended to return one to two days after being discharged. Those who returned with bleeding were most likely to come in six to seven days after.

Older children were more likely to suffer from bleeding problems while younger kids were more likely to experience nausea. 

Trends

The researchers also looked at dexamethasone and antibiotic use over time, as well as the revisit rate during the study period. Dexamethasone use did not change between 2004 and 2010, but the use of antibiotics dropped significantly. The hospital revisit rate remained fairly stagnant.

Mahant and his team have held webinars with hospital administrators to educate them about the study results.

"There is definitely more work that needs to be done to understand how to reduce revisits to hospital for complications," Mahant told CNN. "One way to investigate this is by studying and learning from high-performing hospitals."

Keeping your kid safe

Parents and doctors should discuss the risks and benefits of any surgery, Mahant said.

For some children, a tonsillectomy is the necessary, or sensible option. However, he said, there are many unanswered questions regarding the the benefits of tonsillectomies for treating certain issues, such as sleep apnea.

"Parents should educate themselves about their child’s condition and treatment options, and ask questions so they feel comfortable about their decisions," he said.


soundoff (2,275 Responses)
  1. Arturo Féliz-Camilo

    Reblogged this on El fogoncito and commented:
    Tonsillectomies routine?

    January 20, 2014 at 14:29 | Report abuse | Reply
  2. Diane

    Why are you referring to Jahi McMath in the article? Her surgery was not a routine tonsillectomy and she was high risk as she was already scheduled to go to ICU after her surgery.

    January 20, 2014 at 15:13 | Report abuse | Reply
    • Nobody you know

      Gee, do you think it might be because her case made people more aware of the possible risks of tonsillectomies?

      Just a thought.

      January 20, 2014 at 21:25 | Report abuse |
  3. karek40

    Had my tonsils out under a local when I was 28, opening day of dove season was next day, I went hunting.

    January 20, 2014 at 16:07 | Report abuse | Reply
  4. Sandy Banx

    Interesting study & quite timely with the interest in mcmath case. However, the article appears to insert her in a particular light, I.e., that she had a "routine" tonsillectomy, when the public has learned that she had three intricate procedures in a highly vascular area. The information about "routineness" and standard of care has been promulgated by the family and their "pro bono" attorney. The hospital, bound by HIPPA regs, has not commented about these issues as the mother did not waive these rights on the decedent's behalf.
    When all the information is disseminated, along with any videos that may exist, the inquiry should expand to include larger issues.

    January 20, 2014 at 16:47 | Report abuse | Reply
  5. maggie

    "the quality of care, varies tremedously....my state is flunking health care 101 right now.

    January 20, 2014 at 20:42 | Report abuse | Reply
  6. maggie

    "the quality of care, varies tremendously....my state is flunking health care 101 right now.

    January 20, 2014 at 20:43 | Report abuse | Reply
  7. maggie

    need to be able to get second opinion.

    January 20, 2014 at 20:46 | Report abuse | Reply
  8. maggie

    you should move this up to an article not a blog. It's clear that you don't have the staff to be comparing research data across atate to state and nation to nation. we need more articles that don't dumb down the reader.

    January 20, 2014 at 20:51 | Report abuse | Reply
  9. Montague Parlor

    Never have elective surgery. Never go to a hospital unless there is no other option. Mistakes are made all the time. Medical professionals will go to extreme lengths to hide their or colleagues mistakes.

    January 22, 2014 at 22:40 | Report abuse | Reply
  10. Brian

    I had many bouts of tonsillitis as a child and numerous courses of antibiotics. At age 7 my mum took me to see a chiropractor, and I still have my tonsils. Does anyone ever ask the question..."what do we think causes the tonsils to get infected and then swollen?". Perhaps it is a compromised immune system. Will a child be healthier without them...? Is there an alternative to surgery..?

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