Perioperative respiratory complications in intracapsular tonsillectomy and total tonsillectomy: Is there a difference?

PURPOSE: The primary objective was to determine any difference in perioperative respiratory complications in children undergoing intracapsular tonsillectomy versus those undergoing total tonsillectomy for sleep-disordered breathing or obstructive sleep apnea.

METHODS

All children undergoing total tonsillectomy from November 2015 to December 2017 and intracapsular tonsillectomy from May 2016 to July 2020 for sleep-disordered breathing or obstructive sleep apnea were included in the study.

RESULTS

2408 patients underwent total tonsillectomy whereas 410 patients underwent intracapsular tonsillectomy. The incidence of major respiratory complications was 13.9 % for intracapsular tonsillectomy and 8.9 % for total tonsillectomy in an unmatched cohort and 13.8 % for intracapsular tonsillectomy and 10.5 % for total tonsillectomy in a matched cohort. Surgical technique was not significant for both major (OR:0.969, 95 % CI:0.596-1.573, p = 0.8979) and minor (OR 0.9, 95 % CI:0.431-1.878, p = 0.7785) respiratory complications in the unmatched cohort and also not significant for major (OR:0.996, 95 % CI:0.353 2.809, p = 0.9944) and minor (OR:1.5, 95 % CI:0.66-3.612, p = 0.31) respiratory complications in the matched cohort. Factors associated with an increased incidence of major perioperative respiratory complications in the unmatched cohort included race (Black or African American) (OR:1.768, 95 % CI:1.298-2.409, p = 0.0038), reactive airway disease (OR:1.814, 95 % CI:1.39-2.367, p=<0.0001), and an upper respiratory infection (OR:1.631, 95 % CI:1.095-2.431, p = 0.0161) whereas reactive airway disease (OR:3.596,95 % CI:1.217-10.621, p=<0.0206), an upper respiratory infection (OR:5.779, 95 % CI:1.392-23.99, p = 0.0157), and the presence of obstructive sleep apnea (OR:4.174, 95 % CI:1.242-14.025, p = 0.0208) were significant in the matched cohort.

CONCLUSION

There was no difference in perioperative respiratory complications in children undergoing intracapsular tonsillectomy versus total tonsillectomy.