Perioperative respiratory complications in intracapsular tonsillectomy and total tonsillectomy: Is there a difference?

Purpose: The primary objective was to determine any difference in perioperative respiratory complications in children undergoing intracapsular tonsillectomy versus those undergoing total tonsillectomy for sleep-disordered breathing or obstructive sleep apnea.

Methods: All children undergoing total tonsillectomy from November 2015 to December 2017 and intracapsular tonsillectomy from May 2016 to July 2020 for sleep-disordered breathing or obstructive sleep apnea were included in the study.

Results: 2408 patients underwent total tonsillectomy whereas 410 patients underwent intracapsular tonsillectomy. The incidence of major respiratory complications was 13.9 % for intracapsular tonsillectomy and 8.9 % for total tonsillectomy in an unmatched cohort and 13.8 % for intracapsular tonsillectomy and 10.5 % for total tonsillectomy in a matched cohort. Surgical technique was not significant for both major (OR:0.969, 95 % CI:0.596-1.573, p = 0.8979) and minor (OR 0.9, 95 % CI:0.431-1.878, p = 0.7785) respiratory complications in the unmatched cohort and also not significant for major (OR:0.996, 95 % CI:0.353 2.809, p = 0.9944) and minor (OR:1.5, 95 % CI:0.66-3.612, p = 0.31) respiratory complications in the matched cohort. Factors associated with an increased incidence of major perioperative respiratory complications in the unmatched cohort included race (Black or African American) (OR:1.768, 95 % CI:1.298-2.409, p = 0.0038), reactive airway disease (OR:1.814, 95 % CI:1.39-2.367, p=<0.0001), and an upper respiratory infection (OR:1.631, 95 % CI:1.095-2.431, p = 0.0161) whereas reactive airway disease (OR:3.596,95 % CI:1.217-10.621, p=<0.0206), an upper respiratory infection (OR:5.779, 95 % CI:1.392-23.99, p = 0.0157), and the presence of obstructive sleep apnea (OR:4.174, 95 % CI:1.242-14.025, p = 0.0208) were significant in the matched cohort.

Conclusion: There was no difference in perioperative respiratory complications in children undergoing intracapsular tonsillectomy versus total tonsillectomy.