THROAT study: tertiary hospital retrospective observational audit of tonsillectomy

Abstract

Background

Adenotonsillectomy (AT) is the most common surgical treatment for paediatric obstructive sleep apnoea (OSA). Evolving patient demographics, diagnostic strategies and surgical techniques have prompted the need to reassess complication risks and outcome predictors in contemporary practice.

Aims

To evaluate trends in patient characteristics, surgical techniques and outcomes in paediatric AT over time; and to identify risk factors for post-operative complications and both parent-reported and PSG-confirmed OSA cure in order to develop a predictive tool for AT outcomes.

Methods

This retrospective cohort study reviewed 1,716 children undergoing AT at a tertiary paediatric hospital across two time-separated cohorts. Data were analysed for demographic trends, operative variables, post-operative complications and predictors of OSA resolution, using multivariable regression and subgroup analysis.

Results

The second cohort featured more complex patients, including higher rates of obesity, comorbidity and pre-operative OSA diagnoses. Partial tonsillectomy and coblation use increased, while cold dissection and oral antibiotic use declined. Despite increased patient complexity, general complication rates remained stable. Risk factors for complications included age <2, ASA ≥3, neuromuscular and syndromic conditions, developmental delay and local anaesthetic use. Adenoidectomy increased both complication risk and OSA cure likelihood. Reported oSDB cure rate remained stable while PSG-proven OSA cure rate increased by 38% over time with age 2-6, large tonsils and absence of comorbidities predicting better outcomes.

Conclusions

AT remains an effective treatment for paediatric OSA. Outcomes are influenced by both patient and operative factors. Risk stratification tools such as the proposed STARS model may improve clinical decision-making and resource allocation. These findings support a tailored approach to AT, balancing benefit and risk based on individual patient profiles.