Postoperative Streptococcal Infection Following Pediatric Tonsillectomy: Outcomes by Preoperative Infection Burden

Monday, October 19, 2026

11:42 AM - 11:48 AM PT

Location: 409AB

Presenting Author(s)

Annabella Nilon, BS

Medical Student
Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, United States

Co-Author(s)

AK

Abraham A. Kassem, BS

Research Associate
Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Department of Otolaryngology, Head and Neck Surgery, United States
GF

Gabriella N. Fletcher, n/a

Student
Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
North tonawanda, New York, United States
Alexa F. Ibrahim, BA

Medical Student
Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
Oyster Bay, NY, United States
SK

Sofia Khan, DO

Resident Physician (PGY-2)
Jacobs School of Medicine and Biomedical Sciences at the University of Buffalo
Buffalo, New York, United States

Senior Author(s)

MC

Michele M. Carr, DDS MD MEd PhD

Professor
Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Dept of Otolaryngology
Buffalo, New York, United States

Introduction: Although tonsillectomy is widely performed to reduce infections, evidence regarding its effectiveness in preventing streptococcal throat infections within the first postoperative year remains mixed. This study evaluates whether tonsillectomy reduces the rate of streptococcal throat infections in children postoperatively.

Methods: We conducted a retrospective cohort study using de-identified electronic health record data from TriNetX. Pediatric patients (≤18 years) who underwent tonsillectomy between 2015-2024 were identified, and streptococcal infection was assessed within one year before and after surgery. Postoperative risk was analyzed by preoperative infection burden, with odds ratios, risk ratios, and 95% CIs reported.

Results: A total of 255,454 pediatric patients underwent tonsillectomy. Streptococcal infection was documented in 37,801 (14.8%) patients in the year before surgery and in 7,663 (3.0%) patients in the year after. Tonsillectomy was associated with a reduction in streptococcal pharyngitis diagnoses (OR 5.62, 95% CI 5.48–5.76; RR 0.20, 95% CI 0.20–0.21; p<.001). In the year following surgery, streptococcal pharyngitis occurred in 10.7% (3,243/30,432) of children with 1–2 episodes, 35.7% (1,917/5,375) with 3–4 episodes, 36.1% (572/1,586) with 5–6 episodes, and 44.3% (281/634) ≥7 or more episodes. Although some demographic characteristics differed statistically between cohorts, the absolute differences were small.

Conclusions: Tonsillectomy was associated with a significant reduction in infections the year following surgery. However, children with a higher preoperative burden of infection continued to experience substantial rates of postoperative streptococcal pharyngitis, emphasizing the need for realistic preoperative counseling regarding expected outcomes.