Complications of Tonsillectomy
Tonsillectomy is associated with several potential complications, with bleeding being the most common and potentially life-threatening complication, occurring in 0.2-2.2% (primary) and 0.1-3% (secondary) of cases. 1
Bleeding Complications
- Primary hemorrhage (within 24 hours of surgery): 0.2-2.2% of cases 1
- Secondary hemorrhage (after 24 hours): 0.1-3% of cases 1
- Bleeding may require:
- Readmission for observation
- Further surgery to control bleeding
- Blood transfusion in severe cases
Risk Factors for Post-Tonsillectomy Hemorrhage
- Older age (particularly patients over 11 years) 2
- History of chronic tonsillitis as the surgical indication 2
- Excessive intraoperative blood loss (>50 cm³) 2
- Elevated postoperative mean arterial pressure 2
- Male gender 3
- Use of bipolar diathermy techniques 3
Respiratory Complications
- Respiratory compromise occurs in 1.3-2.4% of general pediatric population and 5.8-26.8% of children with OSA 4
- Specific respiratory complications include:
- Laryngospasm
- Laryngeal edema
- Aspiration
- Postobstructive pulmonary edema
- Respiratory compromise
Operative Complications
- Trauma to nearby structures:
- Teeth
- Larynx
- Pharyngeal wall (constrictor muscle or underlying arterial structures)
- Soft palate
- Difficult intubation
- Endotracheal tube ignition
- Cardiac arrest
- Injury to critical structures:
- Carotid artery injury
- Tongue swelling
- Lip burn
- Eye injury
- Fracture of the mandibular condyle 1
Postoperative Complications
- Pain and discomfort:
- Throat pain (universal)
- Referred otalgia (ear pain)
- Gastrointestinal issues:
- Nausea and vomiting
- Dehydration
- Velopharyngeal insufficiency (can lead to nasal regurgitation) 4
- Nasopharyngeal stenosis
- Fever
- Taste disorders (hypogeusia, ageusia, dysgeusia, phantogeusia) 1
Rare Complications
- Vascular injury
- Subcutaneous emphysema
- Jugular vein thrombosis
- Atlantoaxial subluxation (Grisel syndrome) 1
- Persistent neck pain (Eagle syndrome) 1
Mortality Risk
- Current US reported mortality rates:
- 1 per 2,360 in inpatient settings
- 1 per 18,000 in ambulatory settings 1
- Ontario, Canada reported a combined inpatient/outpatient mortality rate of 1 per 56,000 (2002-2013) 1
- About one-third of deaths are attributable to bleeding
- Remaining deaths related to aspiration, cardiopulmonary failure, electrolyte imbalance, or anesthetic complications 1
- Airway compromise is the major cause of death or major injury in malpractice claims after tonsillectomy 1
Higher Risk Populations
Complications are more common in children with:
- Craniofacial disorders
- Down syndrome
- Cerebral palsy
- Neuromuscular diseases
- Major heart disease
- Bleeding diatheses
- Age under 3 years 1
Post-Discharge Complications
- Approximately 1.3% of patients experience delayed discharge during initial hospital stay
- Up to 3.9% have secondary complications requiring readmission 1
- Primary reasons for readmission include:
- Pain
- Vomiting
- Fever
- Tonsillar bleeding
It's important to note that minor bleeding episodes increase the risk of subsequent severe bleeding episodes, highlighting the importance of close monitoring after any bleeding event 3.