(1030) Post-Tonsillectomy Outcomes in Children With and Without Recent Streptococcal Infection

Introduction: Although recurrent streptococcal tonsillitis is linked to postoperative bleeding, the impact of streptococcal infection in the year prior to tonsillectomy on short-term postoperative outcomes remains unclear and was evaluated using a national database.

Methods: A retrospective TriNetX cohort study (2015–2024) evaluated pediatric tonsillectomy patients stratified by preoperative streptococcal pharyngitis (none vs ≥1 episode). Propensity score matching was performed 1:1 on age, sex, race/ethnicity, procedure type (tonsillectomy vs adenotonsillectomy), tonsillar and adenoid hypertrophy, obstructive sleep apnea, and overweight status. Postoperative bleeding, emergency department visits, inpatient readmission, and hemorrhage requiring operative control were evaluated within 14 days of surgery.

Results: After matching, 36,395 children were included per cohort, with similar mean age (7.76 ± 3.75 years; p =.65) and female sex (53.5%; p = 0.73). Compared with children with ≥1 preoperative streptococcal episode, those without infection had higher rates of postoperative bleeding (4.53% vs 4.08%; RR 1.11, 95% CI 1.04–1.19; p =.002) and inpatient readmission (5.45% vs 4.85%; RR 1.13, 95% CI 1.06–1.20; p = 0.0002), but lower rates of hemorrhage requiring operative control (1.81% vs 2.21%; RR 0.82, 95% CI 0.74–0.91; p <.001). Emergency department utilization within 14 days was more frequent among children with preoperative streptococcal infection (7.77% vs 5.78%; RR 0.74, 95% CI 0.71–0.79; p <.001).

Conclusions: These findings suggest that preoperative streptococcal infection status may help identify children at risk for more clinically significant postoperative hemorrhage despite fewer bleeding diagnoses overall. Incorporating recent infection history into perioperative risk stratification and postoperative counseling may support more tailored monitoring during early recovery.