Complications common for adults after tonsillectomy

Adults have a high rate of complications after getting their tonsils removed, so plan for adequate recuperation after the surgery, researchers say.

"Most of these are not life threatening problems, but people may not be back to work in a hurry," said Dr. David Rosen, a specialist in Otolaryngology and Head and Neck Surgery at Thomas Jefferson University Hospital in Philadelphia.

"Just go into it realistically," said Rosen, who was not involved in the new study. "Most people will feel pretty good in a week, but it may really be more uncomfortable than you think."

Researchers analyzing a database of insurance claims found that one in five adults who had tonsillectomy surgeries also had serious complications within two weeks of the operation. One in 10 went to an emergency room as a result.

Tonsils are clusters of tissue in the throat that are part of the lymphatic system. They can become swollen with infections and can interfere with breathing.

Children commonly have surgery to remove swollen tonsils that cause sleep problems, and they tend to have easier recoveries than adults, which is something most ear, nose and throat doctors already know.

Surgically removing the tonsils can help adults who have repeated cases of strep throat each year or bad sleep apnea. But for adults, recovery isn't always as easy as patients expect.

The researchers examined 36,000 cases of adult outpatient tonsillectomy in a nationwide insurance database and identified patents who had a record of a health problem one, two or four weeks later that may have been related to the surgery.

They were led by Dr. Meena Seshamani, a head and neck surgeon with The Permanente Medical Group in San Francisco.

The team tallied complications including bleeding, pain, dehydration, blood transfusion, dislocation of cervical vertebra and fever, among other conditions.

After one week, 15 percent of patients had at least one possible complication, which rose to 20 percent by the two- and four-week points, according to the results published in Otolaryngology-Head and Neck Surgery.

Pain was the most common complication, affecting 11 percent of patients, compared to the 6 percent who experienced bleeding and 2 percent who had dehydration.

"Keeping yourself well hydrated is usually going to lead to less complications," Rosen said. Having a raw spot in your mouth can make it painful to swallow, especially since some of the liquid medicines people use sting the wound, but if you get dehydrated the scab will fall off and that's how bleeding starts, he said.

"One of the lessons here for surgeons is that we need to give better instructions and a better pain management plan for patients," said Dr. Craig Derkay, professor and vice-chairman of the Department of Otolaryngology Head Neck Surgery at Eastern Virginia Medical School in Norfolk. Derkay was not part of the new study.