Systematic review meta-analysis shows higher complication rates in young children undergoing tonsillectomy

OBJECTIVE: To determine whether children between 2 and 3 years of age are at higher risk of immediate (<24 hours) posttonsillectomy complications and, therefore, require routine overnight observation. DATA SOURCES: Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Scopus, and ClinicalTrials.gov were searched from 1788 to 2023. METHODS: A systematic review was performed in accordance with PRISMA guidelines. Search strategies included terms for tonsillectomy, adenotonsillectomy, hospitalization, overnight stay, children, and infants. Records were checked for duplicates and screened against specific inclusion criteria. Data on immediate postoperative complications (ie, respiratory complications, bleeding, and decreased oral intake) were collected. Meta-analysis was performed using Stata 19.0 (StataCorp LLC). RESULTS: The search yielded 7587 studies, of which 39 met the inclusion criteria. The overall complication rate in children under 3 years was 12.0% (95% CI 8.0%-17.0%). The pooled odds ratio for immediate postoperative respiratory complication in this group was 2.97 (95% CI, 2.3-3.9). Among children aged 2 to 3 years, the overall complication rate was 8.0% (95% CI of 4.0%-13.0%), the respiratory complication rate was 1.0% (95% CI: 0.0%-3.0%), and the poor oral intake rate was 2.0% (95% CI: 1.0%-5.0%). CONCLUSION: Children between 2 and 3 years old have comparable rates of postoperative complications compared to children over 3 years old. As such, ambulatory adenotonsillectomy is likely safe in this age group.