What is the most common surgical procedure performed on pediatric patients?

From the Guidelines

Tonsillectomy is the most common surgical procedure performed on pediatric patients, with 289,000 ambulatory procedures performed annually in children under 15 years of age in the United States. This procedure is defined as a surgical operation that completely removes the tonsil, including its capsule, by dissecting the peritonsillar space between the tonsil capsule and the muscular wall, and is often performed with or without adenoidectomy 1. The American Academy of Otolaryngology–Head and Neck Surgery Foundation has developed evidence-based recommendations on the pre-, intra-, and postoperative care and management of children under consideration for tonsillectomy, highlighting the importance of this procedure in pediatric care 1.

Key Points

• Tonsillectomy is a common surgical procedure in children, with a high volume of procedures performed annually 1.
• The procedure is often performed to treat conditions such as recurrent throat infections, sleep disordered breathing, and obstructive sleep apnea 1.
• The American Academy of Otolaryngology–Head and Neck Surgery Foundation has developed guidelines for the management of children under consideration for tonsillectomy, emphasizing the need for careful evaluation and counseling of families 1.
• While there are potential complications associated with adenotonsillectomy, such as anesthetic-related medical problems and hemorrhage, the benefits of the procedure in treating obstructive sleep apnea syndrome and other conditions can outweigh these risks 1.

Recommendations

• Tonsillectomy should be considered as a treatment option for children with recurrent throat infections, sleep disordered breathing, and obstructive sleep apnea, as it is a common and effective procedure for managing these conditions 1.
• Clinicians should carefully evaluate and counsel families on the potential benefits and risks of tonsillectomy, taking into account individual patient factors and medical history 1.

From the Research

Surgical Procedures in Pediatric Patients

• Tonsillectomy is one of the most common pediatric surgical procedures performed in various regions, including Australasia 2 and the United States 3.
• The primary indications for tonsillectomy are obstructive sleep apnoea (OSA) and recurrent pharyngotonsillitis 2, 4, 5.
• Tonsillectomy can be performed alone or in combination with other procedures, such as adenoidectomy, with adenotonsillectomy being the most common combined procedure 4.
• The procedure is generally well-tolerated, with pain and postoperative haemorrhage being the most common complications 2, 5, 6.

Indications for Tonsillectomy

• Recurrent tonsillitis and sleep-disordered breathing (SDB) are common indications for tonsillectomy in children 4.
• Obstructive sleep apnea (OSA) is a significant indication for tonsillectomy, and polysomnography (PSG) is essential for diagnosis 4.
• Chronic tonsillitis and recurrent tonsillitis are primary indications for tonsillectomy alone 4.

Outcomes and Complications

• Tonsillectomy can improve quality of life and reduce symptoms of OSA and recurrent tonsillitis 2, 4, 3.
• Postoperative bleeding is a significant complication of tonsillectomy and requires emergency attention 2, 5.
• Newer surgical techniques, such as Coblation, may reduce postoperative pain and hemorrhage, leading to shorter recovery times 6.