Tonsil Removal May Be Problematic in Grown-Ups

Tonsillectomy associated with complications and high costs in adults

(RxWiki News) When children get their tonsils removed, there often are few post-op complications, and usually lots of ice cream involved. In adults, however, tonsil removal tends to be a little more complicated, new research shows.

Adults who had their tonsils removed (a procedure called tonsillectomy) commonly had numerous post-op complications, according to this research.

The complications of surgery can cost insurance companies substantial fees, the study's authors added.

"Talk to your surgeon about possible complications after tonsillectomy."

This study was led by Meena Seshamani, MD, PhD, formerly with the Permanente Medical Group in San Francisco, California. The retrospective study involved a large insurance database covering 50 states, including the District of Columbia.

Dr. Seshamani and colleagues looked at data from the MarketScan Commercial claims and Encounters Database. It included people aged 18 to 65 years who had tonsillectomies from 2002 to 2007. The most common reasons adults have their tonsils removed are inflammation of the tonsils and to treat sleep apnea, the researchers noted.

During the time period of the study, 36,210 adult patients had their tonsils removed. Almost 20 percent experienced post-op complications in the 14 days following surgery.

The most common post-op complication was hemorrhage (severe bleeding), experienced by just over 6 percent, the researchers found. This rate compares with only 2 to 4 percent of children who hemorrhage after having their tonsils removed.

About 2 percent of adults had post-op dehydration, and 11 percent reported excessive pain, the study authors noted. Overall, 10 percent of adults visited the emergency room in the days after surgery and 1.5 percent were re-admitted to the hospital.

The researchers found that those most likely to have complications were adults who had co-morbidities (other health problems), those who had taken antibiotics in the year before surgery and people who had peritonsillar abscesses (pus around their tonsils) some time prior to their surgery.

These researchers also found that having a prescription for antibiotics, including on the day of surgery, was associated with a lower rate of complications.

The average payment by insurance companies for a routine tonsillectomy was $3,832, but this increased to $6,388 if the patient experienced hemorrhaging, to $5,753 for post-op dehydration and to $4,708 for managing post-op pain, the authors reported.

Physicians are becoming more aware of how much things cost and try to do things to bring costs down, noted Dr. Rahul Shah, co-chair on the American Academy of Otolaryngology’s Patient Safety and Quality Improvement Committee, in an interview. He said this study will “really help with dialogue with our patients."

Physicians can encourage patients to drink liquids after surgery, even if they have to force themselves to do so, he said. They can also warn patients to follow the discharge instructions for pain control and take their medication as prescribed. “Don’t fall behind with pain control,” he cautioned. If patients follow instructions carefully, post-op complications, and costs can come down, Dr. Shah said. “These are modifiable outcomes.”

This study appears in the April 2014 edition of Otolaryngology-Head and Neck Surgery.

The authors disclosed that one author was a former employee of Truven Health Analytics and two authors are still employed there.

Review Date: 
April 4, 2014