Determinants of early complications of Adenotonsillectomy

Abstract

Background: Adenotonsillectomy (ASTS) is the commonest surgical procedure undertaken in children by otolaryngologists the world over. This operation is associated with various complications the commonest of which include haemorrhage, infection, vomiting and odynophagia. I carried out a prospective study aimed at determining the rate, timing and factors associated with early complications after ASTS at Kenyatta National hospital (KNH), Nairobi, Kenya. Methodology: The patients' demographic data, socio-economic status, history of disease, physical examination findings, experience of the surgeon and anaesthetist doing the operation were entered into a proforma. All the patients were operated using the same surgical technique. Complications arising intraoperatively and two weeks post operatively were recorded. The data obtained was analyzed and conclusions and recommendations drawn from the results. Results: The study was carried out between November 2006 and May 2007 and involved 148 patients ( 96 males and 56 females). Their age range was 1 to 17.5 years with a mean age of 4.73 years (56.76 months). The complications encountered in the early post operative period included haemorrhage, odynophagia, dehydration and fever. The overall complication rate was 33.8% (50 patients). Post tonsillectomy haemorrhage (PTH) occurred in only one patient (0.7%). Most complications in the immediate post operative period occurred in the first eight hours post operatively. Odynophagia was found to be significantly associated with gender and age. Odynopahgia was also significantly associated with weight loss within the first two weeks post operatively. Conclusions: Adenotonsillectomy is a common operation in the under 6 years at KNH. Most complications in the immediate postoperative period occur in the first 8 hours post operatively. The rate of serious complications post adenotonsillectomy is low and thus ASTS can safely be done as day cases at KNH with at least an 8 hour post operative observation period. Female gender and age less than 6 years are important risk factors in the development of prolonged odynophagia post ASTS.