Is it safe for kids to get a tonsillectomy? Guide for parents about risks and complications after 2 'tragic' deaths in Ontario

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Earlier this month, McMaster Children’s Hospital in Hamilton, Ont. announced it “paused scheduled tonsil and adenoid surgical procedures for patients under the age of 18” following the deaths of two patients.

According to a June 4 press release, the decision was made “out of abundance of caution” after two paediatric patients died following discharge from “tonsil and/or adenoid surgery.” One child reportedly died the day after their surgery, while the second died nine days after their initial surgery. Hamilton Health Sciences stated there was “no apparent connection between these two cases,” and no further details, including the cause of death for each child, were given.

“We are also undertaking a comprehensive review by external subject matter experts of our pediatric program for tonsil and adenoid surfers,” the statement read. “Only emergency pediatric tonsil and adenoid surgeries will proceed.”

Dr. Devin Peterson, pediatric chief of surgery at McMaster Children’s Hospital called the deaths “tragic” in a video statement shared to Hamilton Health Sciences’ website. "We are deeply saddened by their deaths and offer our sincere condolences to their families," said Peterson, who added that deaths following tonsil and adenoid surgeries “very rare.”

“McMaster Children’s Hospital is a leading pediatric centre and we take this responsibility very seriously,” he said.

Another child spent 18 days in ICU after tonsillectomy

Following the announcement of an external review, a mother whose daughter experienced bleeding following her tonsillectomy at McMaster Children's Hospital is also speaking out.

Sarah List said her 8-year-old daughter Rosie almost died after experiencing complications from her tonsillectomy in May.

"Most tonsillectomies don't have complications, and to find out two kids died," the Dundas, Ont. mother told CTV News. "It's just so shocking."

Rosie was allegedly discharged a few hours after having her tonsils removed at McMaster Children’s Hospital on May 15. The next morning, List says her daughter began vomiting blood.

"It’s terrifying,” List said. "It was unbelievable to see this massive amount of blood."

Rosie then allegedly returned to the hospital where she was hospitalized for almost three weeks. List says her daughter received three more surgeries and spent four nights in the paediatric intensive care unit.

“No one could tell us what was wrong,” List said. “I was told several times by one of the ENT (ear, nose and throat) residents that this couldn't be from the surgery, that he thought it was unrelated.”

List said her daughter’s health deteriorated and she developed an infection in her bloodstream. In total, Rosie spent 18 days in hospital before she was discharged. Although she is on the mend, List wants her daughter’s case to be part of the hospital’s external review.

Although it's unclear whether the hospital will share the results of their investigation with the public, the news from McMaster Children's Hospital may have some parents wondering if the common surgery is safe.

Yahoo Canada spoke to a pediatric surgeon to understand the risks and potential complications of tonsillectomies and adenoidectomies.

What are the risks of tonsillectomies and adenoidectomies?

Dr. Sam Daniel, surgeon-in-chief at the Montreal Children’s Hospital, said the news from Hamilton has undoubtedly caused many parents to panic.

"It’s very stressful to have your child wait for surgery, and then do see what’s going on [in Hamilton] clearly brings a lot of questions from parents," he told Yahoo Canada.

Although tonsillectomies and adenoidectomies are extremely common procedures, they are still considered "major surgery" by the The Canadian Society of Otolaryngology- Head and Neck Surgery. Daniel said that complications from tonsillectomies are "extremely rare" with deaths occurring in 1 in every 20,000 procedures.

An American retrospective cohort study published in 2022 noted an overall rate of post-operative death is 7 out of 100,000 procedures based on data from five U.S states.

“It’s important for parents to have an open conversation with their surgeon and make sure they’re comfortable with the decision for surgery," Daniel said.

Daniel called tonsillectomies and adenoidectomies "very painful procedures" and said some children may have existing health issues, including cardiac conditions or bleeding disorders, that can make surgery "risky." Because the surgery requires the child to be put under general anesthesia, physicians assess risks before every procedure. If a child does have pre-existing health conditions, medical teams can strategize to minimize risks and in some cases may require a longer hospital stay or increased observation post-op.

"For most children, it's very safe," Daniel said.

What are some of the potential complications from tonsillectomies and adenoidectomies?

Daniel said bleeding can occur within the first 24 hours after surgery (known as primary bleeding) or can occur seven to 14 days later (secondary bleeding). The vessels in the tonsil bed can reopen and bleed or the area can be scratched when eating certain food, like toast. In a vast majority of cases, the bleeding is obvious. Some children may have active bleeds that present as spitting or vomiting blood.

“Any bleeding is obviously very stressful to the family,” he said. “Our advice is to come back to the hospital immediately to be checked. In some cases [the bleeding] stops by itself…in some cases, if the bleeding doesn’t stop, we control it in the emergency room or in rare cases we have to go into the operating room again to control the bleeding.”

Infection can occur following tonsillectomies or adenoidectomies. Fever, redness or red streaks, increased swelling, skin that's warm to the touch or the appearance of pus are all signs of infection and require immediate medical attention.

Do tonsillectomies and adenoidectomies require hospitalization?

In some cases, patients who have their tonsils or adenoids removed are observed in-hospital for several hours following their procedure and then discharged the same day.

Daniel said that at the hospital where he works, if a child has severe medical conditions or sleep apnea, they are kept in hospital overnight or for a few days before being sent home. All patients under 3 years of age are hospitalized for observation before being released.

Daniel says that Montreal Children's Hospital is "very conservative" when it comes to removing tonsils or adenoids. Guidelines have been put in place that require children to meet a certain criteria or have a certain number of infections per year before they are a candidate for surgery.

Parents should speak to their healthcare providers about whether or not surgery to remove tonsils or adenoids would be beneficial to their child's health.

How do you know if your child needs their tonsils or adenoids removed?

According to The Canadian Society of Otolaryngology- Head and Neck Surgery, a person (adult or child) is a good candidate to have their tonsils removed if they experience six episodes of tonsillitis (tonsil infection) per year. Additionally, the organization notes that frequent infections that cause a person to miss 20 days of work or school per year or experiences frequent peritonsillar abscesses (infection near the tonsils) are also signifiers that a tonsillectomy may be required.

Aside from infection, airway blockage is a key indicator that a child may be a candidate for surgery. According to Daniel, some children have a blockage that’s severe enough to distrupt sleep and may impact behaviour or impact bed wetting. Some children may have restricted airway due to enlarged tonsils that makes it difficult to eat.

“In more severe cases, you have sleep apnea, where the oxygen drops down at night and it can be dangerous," he explains. "It can be life-threatening — in severe cases there can be long-term impact on the heart and breathing."

Safe procedures for 'a vast majority of children'

Daniel said that the two deaths in Ontario are "tragic for the families."

“The pain that they’re going through is unspeakable," he continued.

While the public awaits the findings from the external review of McMaster Children's Hospital's pediatric program for tonsil and adenoid surgeries, parents across the country with children awaiting surgeries may continue to worry — but Daniel said that it's a "safe operation" for the "vast majority of children."

"This news can be very unsettling. Any parent who has had a child go through surgery has questions and finds it stressful,” he said. “At the end of the day it’s about weighing the risks and benefits and not to be shy about having conversations with the treating team....At the end of the day, for a vast majority of children, it's a safe operation that improves their quality of life and addresses health risks that need to be addressed."

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