A comprehensive examination of the immediate recovery of children following tonsillectomy and adenoidectomy

Bryan K Lao; Zeev N Kain; Dina Khoury; Brooke N Jenkins; Jeremy Prager; Robert S Stevenson; Brenda Golianu; Jeannie Zuk; Jeffrey I Gold; Qiu Zhong; Michelle A Fortier

doi:10.1016/j.ijporl.2020.110106

A comprehensive examination of the immediate recovery of children following tonsillectomy and adenoidectomy

Int J Pediatr Otorhinolaryngol. 2020 Aug:135:110106. doi: 10.1016/j.ijporl.2020.110106. Epub 2020 May 11.

Authors

Bryan K Lao¹, Zeev N Kain², Dina Khoury³, Brooke N Jenkins⁴, Jeremy Prager⁵, Robert S Stevenson⁶, Brenda Golianu⁷, Jeannie Zuk⁸, Jeffrey I Gold⁹, Qiu Zhong¹⁰, Michelle A Fortier¹¹

Affiliations

¹ Department of Psychiatry & Behavioral Sciences, Duke University Hospital, Duke University School of Medicine, 2301 Erwin Rd, Durham, NC, 27710, USA; UCI Center on Stress & Health, School of Medicine, University of California-Irvine, Irvine, CA, 505 S Main Street, Suite 940, Orange, CA, 92868, USA.
² UCI Center on Stress & Health, School of Medicine, University of California-Irvine, Irvine, CA, 505 S Main Street, Suite 940, Orange, CA, 92868, USA; Department of Anesthesiology and Perioperative Care, University of California-Irvine, 333 City Blvd West, Orange, CA, 92868, USA; Child Study Center, Yale University School of Medicine, 230 S Frontage Rd, New Haven, CT, 06520, USA; American College of Perioperative Medicine, 15333 Culver Drive Suite 340-253, Irvine, CA, 92604, USA.
³ UCI Center on Stress & Health, School of Medicine, University of California-Irvine, Irvine, CA, 505 S Main Street, Suite 940, Orange, CA, 92868, USA.
⁴ UCI Center on Stress & Health, School of Medicine, University of California-Irvine, Irvine, CA, 505 S Main Street, Suite 940, Orange, CA, 92868, USA; Department of Anesthesiology and Perioperative Care, University of California-Irvine, 333 City Blvd West, Orange, CA, 92868, USA; Department of Psychology, Chapman University, 1 University Drive, Orange, CA, 92688, USA.
⁵ Department of Pediatric Otolaryngology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave, Aurora, CO, USA.
⁶ UCI Center on Stress & Health, School of Medicine, University of California-Irvine, Irvine, CA, 505 S Main Street, Suite 940, Orange, CA, 92868, USA; American College of Perioperative Medicine, 15333 Culver Drive Suite 340-253, Irvine, CA, 92604, USA.
⁷ Department of Anesthesiology and Perioperative Medicine, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, USA.
⁸ Department of Surgery and Anesthesiology, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave, Aurora, CO, USA.
⁹ Keck School of Medicine, Departments of Anesthesiology, Pediatrics, And Psychiatry & Behavioral Sciences, University of Southern California, 1975 Zonal Ave, Los Angeles, CA, USA; Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA, USA.
¹⁰ Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, 101 the City Drive South Pavilion II, Orange, CA, 92868, USA; Division of Pediatric Otolaryngology, CHOC Children's Hospital of Orange County, 1201 W La Veta Ave, Orange, CA, 92868, USA.
¹¹ UCI Center on Stress & Health, School of Medicine, University of California-Irvine, Irvine, CA, 505 S Main Street, Suite 940, Orange, CA, 92868, USA; Department of Anesthesiology and Perioperative Care, University of California-Irvine, 333 City Blvd West, Orange, CA, 92868, USA; Sue & Bill Gross School of Nursing, University of California-Irvine, 802 W Peltason Drive, Irvine, CA, 92697, USA; Department of Pediatric Psychology, CHOC Children's, Orange, CA, 1201 West La Veta Ave, Orange, CA, 92868, USA. Electronic address: mfortier@uci.edu.

Abstract

Objectives: Using multiple well-validated measures and a large sample size, the goal of this paper was to describe the immediate clinical and behavioral recovery of children following tonsillectomy with or without an adenoidectomy (T&A) during the first two weeks following surgery.

Study design: Observational, longitudinal study.

Setting: Four major pediatric hospitals in the U.S. consisting of Children's Hospital of Orange County, Children's Hospital of Los Angeles, Lucile Packard Children's Hospital, and Children's Hospital Colorado.

Subjects: and Methods: Participants included 827 patients between 2 and 15 years of age who underwent tonsillectomy with or without adenoidectomy surgery. Baseline and demographic information were gathered prior to surgery, and measures of clinical, behavioral, and physical recovery were recorded immediately following and up through two weeks after surgery.

Results: Pain following T&A was clinically significant through the first post-operative week and nearly resolved by the end of the second week. Negative behavioral changes were highly prevalent after surgery (75.6% of children at Day 0) through the first week (63.9% at Week 1), and over 20% of children continued to evidence new onset negative behavioral changes at two weeks post-operatively. Children were rated as experiencing significant functional impairment in the immediate three days following surgery and most children returned to baseline functioning by the end of the second week.

Conclusions: Results of this study suggest that children show immediate impairment in functioning and experience clinically significant pain throughout the first week following T&A, and new onset maladaptive behavioral changes persisting even up to the two-week assessment period.

Keywords: Adenoidectomy; Ambulatory surgery; Pain; Pediatric; Recovery; Tonsillectomy.

MeSH terms

Adenoidectomy / adverse effects*
Adolescent
Adolescent Behavior
California
Child
Child Behavior*
Child, Preschool
Colorado
Female
Hospitals, Pediatric
Humans
Longitudinal Studies
Male
Pain, Postoperative / epidemiology*
Postoperative Complications* / epidemiology
Postoperative Complications* / psychology
Prevalence
Surveys and Questionnaires
Tonsillectomy / adverse effects*

Grants and funding

R01 HD048935/HD/NICHD NIH HHS/United States