Our Summary

This research paper looks at how the health status of a patient before surgery can predict the risk of complications after a tonsillectomy (removal of tonsils) and/or adenoidectomy (removal of adenoids). The researchers used a health rating system from the American Society of Anesthesiologists, called ASA-PS, which ranks patients from I (healthy) to V (moribund).

They looked at data from a national database of surgical outcomes for patients aged 16 or older who had tonsillectomy and/or adenoidectomy surgeries between 2005 and 2016. They compared those in the healthy or mildly unhealthy categories (ASA I/II) to those in the severe or critical categories (ASA III/IV).

The results showed that patients in the higher-risk categories (III and IV) were more likely to be readmitted to the hospital, have complications, need another surgery, or stay longer in the hospital after their procedures.

The study concludes that understanding a patient’s health status before surgery can help predict problems afterward. Therefore, doctors should strive to improve the overall health of higher-risk patients before surgery and have specific plans for their care afterward to reduce the chance of complications and the overall cost of healthcare.

FAQs

  1. What is the American Society of Anesthesiologists’ health rating system (ASA-PS)?
  2. How does a patient’s health status before surgery impact their risk of complications after a tonsillectomy or adenoidectomy?
  3. What measures can doctors take to reduce the chance of complications and the overall cost of healthcare for higher-risk patients undergoing tonsillectomy or adenoidectomy?

Doctor’s Tip

A doctor may advise a patient undergoing an adenoidectomy to maintain good overall health before the surgery. This can include eating a balanced diet, getting regular exercise, staying hydrated, and avoiding smoking or excessive alcohol consumption. By being in optimal health, the patient may have a lower risk of complications and a faster recovery after the procedure.

Suitable For

Patients who are typically recommended adenoidectomy are those who have recurrent or chronic infections of the adenoids, obstructive sleep apnea, chronic sinusitis, or other nasal airway obstructions. Adenoidectomy may also be recommended for patients with chronic ear infections or middle ear fluid buildup that is not responsive to other treatments. Additionally, patients with a deviated septum or other structural abnormalities in the nasal passages may benefit from adenoidectomy.

Timeline

Before adenoidectomy:

  • Patients typically experience symptoms such as chronic nasal congestion, difficulty breathing through the nose, recurrent ear infections, snoring, and sleep apnea.
  • They may undergo imaging tests or a physical examination to confirm enlarged adenoids as the cause of their symptoms.
  • The patient and their healthcare provider will discuss the risks and benefits of adenoidectomy, as well as any alternative treatment options.

After adenoidectomy:

  • Patients may experience some discomfort, pain, or a sore throat in the days following the surgery.
  • They will need to follow post-operative care instructions provided by their healthcare provider, such as avoiding strenuous activities, eating soft foods, and taking prescribed pain medication.
  • Patients will have follow-up appointments with their healthcare provider to monitor their healing progress and address any concerns or complications that may arise.
  • Over time, patients should experience improved breathing, reduced snoring, and a decrease in ear infections as a result of the adenoidectomy.

What to Ask Your Doctor

When considering adenoidectomy surgery, patients should ask their doctor the following questions:

  1. What is the reason for recommending an adenoidectomy in my case?
  2. What are the potential risks and complications associated with adenoidectomy surgery?
  3. How will my health status affect the outcome of the surgery?
  4. What is my ASA-PS classification and how does it impact the risk of complications?
  5. Are there any specific steps I can take to improve my health before the surgery?
  6. What is the expected recovery time after adenoidectomy surgery?
  7. Will I need any follow-up appointments or care after the surgery?
  8. What are the potential long-term effects of adenoidectomy surgery?
  9. Are there any alternative treatment options to consider?
  10. How experienced are you in performing adenoidectomy surgeries and what is your success rate?

Reference

Authors: Shakhtour LB, Mamidi IS, Lee R, Li L, Jones JW, Matisoff AJ, Reilly BK. Journal: Am J Otolaryngol. 2023 Jul-Aug;44(4):103898. doi: 10.1016/j.amjoto.2023.103898. Epub 2023 Apr 13. PMID: 37068319