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Predictors of Tonsillectomy after Previous Adenoidectomy for Upper Airway Obstruction

Objective: 1) Characterize risk factors for subsequent tonsillectomy in pediatric patients undergoing primary adenoidectomy for upper airway obstruction.2) Compare rates of subsequent tonsillectomy between adenoidectomy patients with and without upper airway obstruction. Method: A retrospective cohort of patients undergoing adenoidectomy without tonsillectomy at the University of Missouri between 1995 and 2010 was examined using billing records and selected chart review. A nested case-control study with detailed chart review was then conducted to determine predictors of subsequent tonsillectomy in patients with upper airway obstruction. Results: Of 1291 patients identified in the retrospective cohort, 7.8% later underwent tonsillectomy. Using a fitted multiple logistic regression model, age less than 3 years (P = .027), female sex (P < .0001), and upper airway obstruction (P = .001) were all found to be significant predictors of subsequent tonsillectomy. In the nested case-control study, potential predictors investigated included adenoidectomy indications, symptoms, smoke exposure, weight, comorbidities, and adenoid and tonsil size at the time of adenoidectomy. Of these, only tonsil size was significant, with each increase in size of 1 (eg, from 2+ to 3+) associated with an increased odds of future tonsillectomy of 2.5 (P = .01). Conclusion: Patients undergoing adenoidectomy for upper airway obstruction are at increased risk of subsequent tonsillectomy when compared with those with other indications. Within this subgroup of patients with upper airway obstruction, young age, female sex, and large tonsil size may further increase the risk of subsequent tonsillectomy after previous adenoidectomy.