• Julie L Goldman, Reginald F Baugh, Louise Davies, Margaret L Skinner, Robert J Stachler, Jean Brereton, Lee D Eisenberg, David W Roberson, and Michael J Brenner.
• Division of Otolaryngology, Department of Surgery, University of Louisville, Louisville, Kentucky.
• Laryngoscope. 2013 Oct 1;123(10):2544-53.

Objective/HypothesisTo report data on death or permanent disability after tonsillectomy.Study DesignElectronic mail survey.MethodsA 32-question survey was disseminated via the American Academy of Otolaryngology-Head and Neck Surgery electronic newsletter. Recipients were queried regarding adverse events after tonsillectomy, capturing demographic data, risk factors, and detailed descriptions. Events were classified using a hierarchical taxonomy.ResultsA group of 552 respondents reported 51 instances of post-tonsillectomy mortality, and four instances of anoxic brain injury. These events occurred in 38 children (71%), 15 adults (25%), and two patients of unstated age (4%). The events were classified as related to medication (22%), pulmonary/cardiorespiratory factors (20%), hemorrhage (16%), perioperative events (7%), progression of underlying disease (5%), or unexplained (31%). Of unexplained events, all but one occurred outside the hospital. One or more comorbidities were identified in 58% of patients, most often neurologic impairment (24%), obesity (18%), or cardiopulmonary compromise (15%). A preoperative diagnosis of obstructive sleep apnea was not associated with increased risk of death or anoxic brain injury. Most events (55%) occurred within the first 2 postoperative days. Otolaryngologists who reported performing <200 tonsillectomies per year were more likely to report an event (P < .001).ConclusionsThis study, the largest collection of original reports of post-tonsillectomy mortality to date, found that events unrelated to bleeding accounted for a preponderance of deaths and anoxic brain injury. Further research is needed to establish best practices for patient admission, monitoring, and pain management.Level Of EvidenceN/A.Copyright © 2012 The American Laryngological, Rhinological and Otological Society, Inc.

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