Serious Complications following Tonsillectomy: How Frequent Are They Really?

Abstract

<b><i>Introduction:</i></b> Quality assurance in health care involves the evaluation of outcomes, cost-benefit ratios, and access to the delivery system. This literature review was undertaken to clarify the incidence of serious posttonsillectomy complications to better understand the outcome component of quality assurance. <b><i>Material and Methods:</i></b> A Medline review was undertaken using the key word ‘tonsillectomy' AND each of the following: ‘serious', ‘complications' and ‘review'; ‘meta-analysis', ‘Cochrane'; ‘life-threatening', ‘death' and ‘disability'. <b><i>Results:</i></b> 454 articles were identified with the following search items in combination with ‘tonsillectomy': ‘serious' (154), ‘complications', ‘review' (24), ‘meta-analysis' (38), ‘Cochrane' (43), ‘life-threatening' (87), ‘death' (91), ‘disability' (17). Sixty-seven articles described a complication rate and were therefore eligible for review: 22 case reports, 9 case series, 2 questionnaires and 33 studies with a more or less precise complication rate were obtainable. Most articles (n = 30) reported the rate of posttonsillectomy hemorrhage with a considerable range. Fifteen articles reported the incidence of death, which ranged from 1:7,132 to 1:170,000 and almost always resulted from excessive hemorrhage. All other complications were mentioned in case reports. <b><i>Conclusion:</i></b> The most common postoperative complication of tonsillectomy is bleeding. However, the incidence varies considerably across studies depending on the study design, follow-up and definition of postoperative bleeding. Other serious adverse events, such as neurological disabilities, emphysema (with or without pneumomediastinum), or vascular problems outside the neck are infrequent.