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Tonsillectomy

Key sources
The following summarized guidelines for the evaluation and management of tonsillectomy are prepared by our editorial team based on guidelines from the British Thoracic Society (BTS 2023), the Kidney Disease: Improving Global Outcomes Foundation (KDIGO 2021), the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF 2019; 2011), the Danish Health Authority (DHA 2016), the Japanese Society of Nephrology (JSN 2016), and the Infectious Diseases Society of America (IDSA 2012).
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Guidelines

1.Diagnostic investigations

Sleep questionnaires: consider using sleep questionnaires combined with clinical examination to identify moderate or severe sleep-disordered breathing in pediatric patients to help decide on pursuing tonsillectomy to improve the airway.
E
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  • Assessment of comorbidities

  • Preoperative polysomnography

  • Preoperative overnight pulse oximetry

2.Perioperative care

Perioperative antibiotics: do not administer perioperative antibiotics in pediatric patients undergoing tonsillectomy.
D

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  • Intraoperative corticosteroids

  • Postoperative inpatient monitoring

  • Postoperative pain management

3.Surgical interventions

Setting of care: consider performing tonsillectomy as outpatient surgery in adult and older pediatric (> 4 years or > 20 kg) patients.
E

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  • Indications for tonsillectomy (recurrent throat infections)

  • Indications for tonsillectomy (IgA nephropathy)

  • Indications for tonsillectomy (sleep-disordered breathing)

  • Indications for tonsillectomy (obstructive symptoms)

4.Patient education

Patient education
Counsel pediatric patients and caregivers and explain that obstructive sleep-disordered breathing may persist or recur after tonsillectomy and may require further management.
B
Counsel pediatric patients and caregivers regarding the importance of managing post-tonsillectomy pain as part of the perioperative education process and reinforce the counseling at the time of surgery with reminders about the need to anticipate, reassess, and adequately treat pain after surgery.
B

5.Follow-up and surveillance

Postoperative assessment of bleeding
Follow-up pediatric patients and caregivers after tonsillectomy and document the presence or absence of bleeding within 24 hours of surgery (primary bleeding) and bleeding occurring > 24 hours after surgery (secondary bleeding) in the medical record.
B
Determine the rate of primary and secondary post-tonsillectomy bleeding at least annually.
B

More topics in this section

  • Postoperative polysomnography