Tonsillectomy: Useful But Not Without Risk

I've been fascinated by the case of Jahi McMath, who is the girl who suffered surgical complications after a tonsillectomy and has been left brain dead. I'll be discussing other aspects of this case next week but I thought I'd invite fellow medical musketeer and ENT physician, Dr. Richard Mabry, by to discuss the risks/benefits of this procedure.

I happily endorsed Richard's forthcoming novel Critical Condition. It's a great story and gives insight into that elusive area of the hospital-- the OR. I hope you'll check it out when it's released in April.

Welcome back, Richard!

Any resident physician in otolaryngology (ear, nose and throat) can tell you that tonsillectomy is not a benign procedure. It’s very useful when indicated, but strict criteria for its consideration have been developed.  These include recurrent documented infections as well as sleep-disordered breathing. Attention to these criteria is important before tonsillectomy is considered.

Prior to the procedure, parents should feel free to ask questions or seek clarification of any points they don’t understand. Most physicians have instruction sheets that are given to help prepare families for the procedure.

The procedure itself is typically short—30 to 60 minutes—after which the child is observed in the recovery room until they are fully awake and stable. The child may be discharged later that day if they’re doing well, but sometimes complications necessitate an overnight stay.

The risk associated with a general anesthetic administered by competent personnel is tiny. Probably equally or more important is the possibility of complications occurring after the procedure. 

Undoubtedly, the number one risk is post-operative bleeding. If the child expectorates clots or large amounts of bright blood, parents should seek medical attention immediately. They are also warned to watch for and report fever, persistent vomiting, or difficulty breathing.

The tonsils receive their blood supply from branches of five different arteries, so bleeding—at surgery and afterward—can be a problem. To deal with this possibility, various methods—primarily application of caustic chemicals, use of ligatures, or various types of cauterization—have been traditionally been used. In recent years, surgical methods other than sharp dissection have become more popular. These include partial tonsillectomy and use of lasers to remove tonsil tissue. Thus far, the perfect solution hasn’t been found.

What are the risks associated with tonsillectomy? According to a recent journal article, the risk of dying from the operation ranges from 1 in 10,000 to 1 in 35,000 cases. Although mortality (i.e., dying) is rare, morbidity (i.e., complications) still occur. The most important, of course, is bleeding after the surgery. In one study, the incidence of bleeding was reported at from 2% to 3% of cases. The two most common times for post-tonsillectomy bleeding to occur are immediately after the surgery and after about a week, when scabs separate.

Does that mean that all parents should shy away from a tonsillectomy for their child? Not at all. It’s a very beneficial procedure when indicated and performed by a competent physician. But it behooves every parent to ask questions, learn what to watch for, and participate in the care of their child while they recover from the surgery.

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Richard Mabry is a retired physician, past Vice President of the American Christian Fiction Writers, and author of “medical suspense with heart.” His novels have been a semifinalist for International Thriller Writers’ debut novel, finalists for the Carol Award and Romantic Times’ Reader’s Choice Award, and winner of the Selah Award. You can follow Richard on his blog, on Twitter, and his Facebook fan page.