(1015) Emergency Department Utilization, Hemorrhage, and Respiratory Complications After Pediatric Tonsillectomy

Introduction: Post-tonsillectomy emergency department (ED) utilization, hemorrhage, and perioperative adverse respiratory events (PRAEs) are important safety outcomes in pediatric tonsillectomy. Administrative claims databases enable large-scale assessment of real-world event rates and risk factors.

Methods: The PearlDiver Mariner database was queried to identify pediatric patients undergoing first tonsillectomy between 2010 and 2024. Comorbidities were captured in a 6-month preoperative window, and complications were assessed within 15 postoperative days using ICD-9/10 and CPT codes. Major PRAEs included respiratory failure, arrest, asphyxia, intubation, and mechanical ventilation; minor PRAEs included stridor, hypoxemia, laryngospasm, and bronchospasm. Multivariable logistic regression evaluated ED utilization, bleeding, and PRAEs, adjusting for age, Charlson Comorbidity Index (CCI), percent insured by zip code, surgeon volume, BMI percentile category, and comorbidities.

Results: A total of 79,891 patients were identified; 29.9% had obstructive sleep apnea (OSA) and 45.2% chronic tonsillitis. BMI data were available in 7.0%, of whom 39.3% had BMI >95th percentile. The 15-day ED visit rate was 8.8%. Bleeding diagnosis and operative take-back rates were 2.7% and 1.3%. Major and minor PRAE rates were 0.2% and 0.6%. Higher odds of ED visits were associated with older age, higher CCI, OSA, chronic tonsillitis, and Down syndrome (p < 0.05). Bleeding diagnosis was associated with older age, higher CCI, and craniofacial anomalies. Major PRAEs were associated with younger age, higher CCI, lower surgeon volume, BMI >95th percentile, OSA, chronic tonsillitis, craniofacial anomalies, and neuromuscular disorders.

Conclusions: Early postoperative utilization and adverse events after pediatric tonsillectomy were influenced by numerous comorbidities. Respiratory complications were more prevalent in younger children with higher comorbidity burden, severe obesity, OSA, and syndromic conditions. These findings supporting targeted perioperative risk stratification and postoperative monitoring.