Pediatric adenoidectomy: What is the effect of obstructive symptoms on the likelihood of future surgery?

Objective: Determine if pediatric patients undergoing adenoidectomy for obstruction have an increased likelihood of undergoing eventual tonsillectomy and/or second adenoidectomy over extended follow-up. Methods: Retrospective cohort study within the ambulatory surgery component of a tertiary children's hospital. Exclusion criteria consisted of the presence of significant co-morbid conditions (obesity, craniofacial syndrome, cerebral palsy, etc.) and less than 1 year of post-adenoidectomy follow-up. The study population included 100 children (mean age = 3.9 years, range 0.9-15 years) randomly selected from a financial billing database undergoing adenoidectomy either with pre-operative obstructive symptoms (OB n = 52) or without pre-operative obstructive symptoms (NOB n = 48) with a minimum of 1 year of retrospective follow-up. Electronic records were searched for subsequent surgery (tonsillectomy and/or revision adenoidectomy). Results: Overall, 29 of 100 children (29%) underwent subsequent surgery (tonsillectomy and/or revision adenoidectomy) over an average of 3.46 years (range 1.0-6.59 years) retrospective follow-up. Children in the OB group were three times more likely (age, sex adjusted odds ratio = 3.03, 95% confidence interval = 1.18-7.78 p = 0.021) than children in the NOB group to require tonsillectomy or second adenoidectomy. Age less than 2 years at time of initial adenoidectomy also suggested an increased likelihood of subsequent surgery. Conclusion: Children undergoing adenoidectomy with obstructive symptoms are more likely to require eventual tonsillectomy and/or second adenoidectomy than those undergoing adenoidectomy without obstruction. However, the low absolute likelihood of future surgery precludes a generalized recommendation for tonsillectomy in these children. (C) 2006 Elsevier Ireland Ltd. All rights reserved.