Pediatric patients who underwent adenotonsillectomy had greater odds of hospital visits for acute upper respiratory tract infections during the latter 2 follow-up periods and for acute lower respiratory tract infections during all 3 postoperative periods compared with children who did not undergo the procedure, according to a retrospective nationwide cohort study published in the Journal of Rhinology.
Investigators analyzed Korean National Health Insurance Service sample cohort data from 2010 to 2017. The study included 6,848 pediatric patients who underwent adenotonsillectomy and 34,240 nonsurgical controls matched 1:5 by age and sex. Patients were stratified by age as 0 to 4 years, 5 to 9 years, or 10 to 14 years for subgroup analyses.
Respiratory tract infection (RTI)-related hospital visits were assessed during the year prior to the index date and during each of the 3 subsequent years. Diagnoses were identified using International Classification of Diseases, 10th Revision codes and categorized as acute upper RTIs, influenza or pneumonia, and acute lower RTIs.
The distributions of age, sex, and insurance premium quintiles were comparable between groups, although preoperative RTI-related visit rates were higher in the adenotonsillectomy group. During the year prior to surgery, 79% of patients in the adenotonsillectomy group vs 71% of controls had an acute upper RTI-related visit, 13% vs 10% had an influenza- or pneumonia-related visit, and 72% vs 69% had an acute lower RTI-related visit.
Multivariable logistic regression models were adjusted for age, sex, insurance premium quintile, and prior health care utilization for each respiratory condition during the year prior to the index date. Investigators also conducted subgroup analyses according to age, sex, and preoperative infection history.
Compared with matched nonsurgical controls, patients who underwent adenotonsillectomy had higher odds of acute upper RTI-related visits during postoperative years 1 to 2 and 2 to 3. Higher odds of acute lower RTI-related visits were observed within the first postoperative year and during years 1 to 2 and 2 to 3. Influenza- or pneumonia-related visits showed no statistically significant difference between the groups.
Age-stratified analyses showed higher odds of lower RTI-related visits among patients aged 0 to 4 years during the first 2 postoperative years, among those aged 5 to 9 years during years 1 to 2, and among those aged 10 to 14 years during years 2 to 3. Sex-stratified analyses showed higher odds of lower RTI-related visits among boys during years 1 to 2 and higher odds of influenza- or pneumonia-related visits among girls during years 2 to 3.
“These findings should be interpreted with caution because the subgroup analyses were exploratory and may have been influenced by temporal variation in circulating respiratory pathogens and other unmeasured factors,” wrote lead author Jun Young Kim, MD, of the Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine in Seoul, Republic of Korea, and colleagues.
Among patients without preoperative influenza or pneumonia, adenotonsillectomy was associated with greater odds of upper RTI-related visits during years 1 to 2 and lower RTI-related visits throughout all 3 postoperative periods. Among patients without prior lower RTIs, greater odds of lower RTI-related visits were found during the first postoperative year and years 2 to 3, while greater odds of upper RTI-related visits were found during years 2 to 3.
The findings are consistent with current clinical guidance that recurrent respiratory tract infections alone are not a principal indication for adenotonsillectomy. The investigators concluded that the procedure should not be performed solely with the expectation of reducing RTI frequency.
The investigators noted that diagnoses were based on administrative codes rather than direct clinical assessment. The primary indication for adenotonsillectomy was not consistently available. The data set also lacked information on symptom severity, laboratory findings, and environmental factors. The investigators also cited potential surveillance bias, noting that differences in health care use and postoperative follow-up could have affected RTI diagnosis and coding. As a result, the findings may not reflect higher infection incidence. Infections that did not result in hospital visits may not have been captured. Asthma, allergic rhinitis, atopic dermatitis, and chronic rhinosinusitis were not included in the analysis, leaving the possibility of residual confounding. The study could not address outcomes occurring beyond the 3-year observation period.
The study was supported by grants from the Korean Society of Otorhinolaryngology-Head and Neck Surgery and the Korean Rhinologic Society. The investigators reported no potential conflicts of interest.
Source: Journal of Rhinology