(204) Association Between Incision and Drainage of Peritonsillar Abscess and Subsequent Tonsillectomy

Introduction: Peritonsillar abscess (PTA) is a common deep neck space infection, yet the impact of initial management on the likelihood of subsequent tonsillectomy remains unclear. Specifically, whether incision and drainage (I&D) influences long-term surgical outcomes has not been well characterized at a population level.

Methods: A retrospective cohort study was performed in January 2026 using a large federated healthcare database. Patients diagnosed with peritonsillar abscess were stratified into those requiring incision and drainage and those managed without drainage. The primary outcome was subsequent tonsillectomy. Outcomes were assessed at 1–30 days, 31–90 days, 91–180 days, 181–365 days, and beyond one year following diagnosis. Relative risks (RRs) with 95% confidence intervals (CIs) were calculated to compare tonsillectomy rates between groups.

Results: Patients with peritonsillar abscess requiring incision and drainage demonstrated a significantly increased risk of subsequent tonsillectomy across all time periods compared with those managed without drainage. Relative risk was elevated at 1–30 days (RR 1.255; 95% CI, 1.084–1.453), with a pronounced increase at 31–90 days (RR 2.389; 95% CI, 2.126–2.685). Increased risk persisted at 91–180 days (RR 2.256; 95% CI, 1.928–2.640), 181–365 days (RR 2.236; 95% CI, 1.865–2.682), and beyond one year (RR 2.234; 95% CI, 1.913–2.609). All comparisons were statistically significant (p < 0.0001).

Conclusions: Incision and drainage of peritonsillar abscess is associated with a significantly increased risk of subsequent tonsillectomy, particularly within the first three months following diagnosis, with sustained elevation beyond one year. These findings may inform patient counseling and clinical decision-making regarding long-term management following PTA.