Clinical evaluation of early and delayed post-operative complications following tonsillectomy. A prospective longitudinal observational study.

Dr. Sanjay  Pathlavath; Dr. Kavya S; Dr. Lavuri  Nagaraju

doi:10.51168/sjhrafrica.v6i12.2264

Authors

Dr. Sanjay Pathlavath Associate Professor, Department of Otorhinolaryngology, Government Medical College and General Hospital, Nalgonda, Telangana, India
Dr. Kavya S Senior Resident, Department of Otorhinolaryngology, Government Medical College and General Hospital, Nalgonda, Telangana, India
Dr. Lavuri Nagaraju Senior Resident, Department of Otorhinolaryngology, Government Medical College and General Hospital, Nalgonda, Telangana, India

DOI:

https://doi.org/10.51168/sjhrafrica.v6i12.2264

Keywords:

Tonsillectomy, postoperative complications, reactionary hemorrhage, secondary hemorrhage, uvular edema, Ear Nose, and Throat surgery

Abstract

Background:
Tonsillectomy remains one of the most frequently performed ENT procedures, yet postoperative complications continue to influence recovery, patient safety, and resource utilization. Understanding the pattern of early and delayed complications helps refine perioperative practices and improve outcomes.

Aim:

To evaluate the early and delayed postoperative complications following tonsillectomy and determine their association with demographic and clinical variables.

Methods:

A prospective observational study was conducted among 50 patients aged 8–30 years undergoing tonsillectomy by the dissection and snare method. Baseline data, preoperative symptoms, tonsillar hypertrophy grade, early complications (≤24 hours), and delayed complications (up to 6 months) were recorded. Statistical analysis was performed using the Chi-square test, with p < 0.05 considered significant.

Results:

Most participants belonged to the 11–20-year group (74%), and females constituted 56%. Odynophagia (88%) and throat pain (84%) were the most common preoperative symptoms. Grade III tonsillar hypertrophy predominated (46%). Early complications were frequent, with oropharyngeal pain (82%), uvular edema (24%), and referred otalgia (22%) being the most common. Reactive hemorrhage occurred in 6%. Delayed complications included secondary hemorrhage (8%) and infection (6%), while no cases of tonsillar remnants or postoperative voice change were observed. Age showed a significant association with both early and delayed complications (p = 0.04), with higher rates in younger patients. Gender and tonsillar grade showed no statistically significant correlation.

Conclusion:

Oropharyngeal pain and uvular edema were the predominant early postoperative events, while secondary hemorrhage represented the most frequent delayed complication. Younger age groups exhibited higher susceptibility to postoperative morbidity.

Recommendations:

Strengthening preoperative counselling for younger patients, standardising analgesic protocols, ensuring meticulous surgical technique, and implementing structured postoperative monitoring may reduce complication rates. Regular auditing of outcomes is recommended to enhance patient safety and refine clinical practice.

Author Biographies

Dr. Sanjay Pathlavath, Associate Professor, Department of Otorhinolaryngology, Government Medical College and General Hospital, Nalgonda, Telangana, India

completed both his MBBS and MS (Otorhinolaryngology) at Kakatiya Medical College, Warangal, under Dr. NTR University of Health Sciences, Vijayawada, Andhra Pradesh. Before joining regular government service, he worked as a Civil Assistant Surgeon on a contract basis at Area Hospital, Nagarkarnul. He later served as a Civil Assistant Surgeon at the Government Primary Health Centre, Gangapur, for three years. After completing his postgraduate training, he worked as an Assistant Professor of ENT at Government Medical College and Hospital, Suryapet, for four years. He is currently serving as an Associate Professor, Department of ENT, Government Medical College and Hospital, Nalgonda, Telangana. His professional interests include clinical otology, rhinology, and optimizing surgical outcomes in ENT practice. ORCID iD: https://orcid.org/0009-0002-4916-7517

Dr. Kavya S , Senior Resident, Department of Otorhinolaryngology, Government Medical College and General Hospital, Nalgonda, Telangana, India

completed her MBBS from Pushpagiri Medical College, Thiruvalla, Kerala (Batch 2013), graduating in 2018 and completing her compulsory internship in 2019. She pursued her MS in Otorhinolaryngology at Kakatiya Medical College, Warangal, Telangana (Batch 2021), completing the program in 2025. She is currently serving as a Senior Resident in the Department of ENT at Government Medical College, Nalgonda. Her academic interests include outcomes of tonsillectomy, upper airway disorders, and clinical research in ENT. She is committed to evidence-based practice and patient-focused otorhinolaryngology care.

Dr. Lavuri Nagaraju , Senior Resident, Department of Otorhinolaryngology, Government Medical College and General Hospital, Nalgonda, Telangana, India

is a Senior Resident in the Department of ENT at Government General Hospital and Government Medical College, Nalgonda. He completed his MBBS from Osmania Medical College, Koti, Hyderabad (Batch 2014; passed out in 2020). He pursued his postgraduate training in Otorhinolaryngology at Kakatiya Medical College, Warangal (Batch 2021), completing his MS (ENT) in April 2025. His clinical interests include otology, airway disorders, and postoperative outcomes in ENT surgeries. He is committed to evidence-based practice and ongoing academic contribution within the specialty.

References

Odhagen E, Alm F, Axelsson S, Hemlin C, Nerfeldt P, Stalfors J, et al. Long-term complications after tonsil surgery: an analysis of 54,462 patients from the Swedish Quality Register for Tonsil Surgery. Front Surg. 2023 Dec 12;10:1304471. doi: 10.3389/fsurg.2023.1304471. PMID: 38148748; PMCID: PMC10749945. https://doi.org/10.3389/fsurg.2023.1304471

Panarese A, Clarke RW, Yardley MP. Early post-operative morbidity following tonsillectomy in children: implications for day surgery. J Laryngol Otol. 1999 Dec;113(12):1089-91. doi: 10.1017/s0022215100157962. PMID: 10767922. https://doi.org/10.1017/S0022215100157962

Lao BK, Kain ZN, Khoury D, Jenkins BN, Prager J, Stevenson RS, et al. A comprehensive examination of the immediate recovery of children following tonsillectomy and adenoidectomy. Int J Pediatr Otorhinolaryngol. 2020 Aug;135:110106. doi: 10.1016/j.ijporl.2020.110106. Epub 2020 May 11. PMID: 32422367; PMCID: PMC7308207. https://doi.org/10.1016/j.ijporl.2020.110106

Freburg-Hoffmeister DL, Hardeman JH, Dolwick MF, Widmer CG. Evaluation of Early Postoperative Complications Following Tracheotomy. J Oral Maxillofac Surg. 2017 Dec;75(12):2701-2706. doi: 10.1016/j.joms.2017.05.009. Epub 2017 May 24. PMID: 28627359. https://doi.org/10.1016/j.joms.2017.05.009

Stuck BA, Götte K, Windfuhr JP, Genzwürker H, Schroten H, Tenenbaum T. Tonsillectomy in children. Dtsch Ärztebl Int. 2008 Dec;105(49):852-60; quiz 860-1. doi: 10.3238/arztebl.2008.0852. Epub 2008 Dec 5. PMID: 19561812; PMCID: PMC2689639.

Sampaio AL, Pinheiro TG, Furtado PL, Araújo MF, Olivieira CA. Evaluation of early postoperative morbidity in pediatric tonsillectomy with the use of sucralfate. Int J Pediatr Otorhinolaryngol. 2007 Apr;71(4):645-51. doi: 10.1016/j.ijporl.2006.12.016. Epub 2007 Feb 2. PMID: 17275926. https://doi.org/10.1016/j.ijporl.2006.12.016

Zagólski O, Gajda M, Stręk P, Kozlowski MJ, Gądek A, Nyzio J. Adult tonsillectomy: postoperative pain depends on indications. Braz J Otorhinolaryngol. 2016 Sep-Oct;82(5):589-95. doi: 10.1016/j.bjorl.2015.11.010. Epub 2016 Feb 16. PMID: 26948105; PMCID: PMC9444663. https://doi.org/10.1016/j.bjorl.2015.11.010

Lawlor CM, Riley CA, Carter JM, Rodriguez KH. Association Between Age and Weight as Risk Factors for Complication After Tonsillectomy in Healthy Children. JAMA Otolaryngol Head Neck Surg. 2018 May 1;144(5):399-405. doi: 10.1001/jamaoto.2017.3431. PMID: 29543971; PMCID: PMC5876815. https://doi.org/10.1001/jamaoto.2017.3431

Mohammadpour-Maleki A, Rasoulian B. Post-tonsillectomy Hemorrhage: A Seven-year Retrospective Study. Iran J Otorhinolaryngol. 2021 Sep;33(118):311-318. doi: 10.22038/ijorl.2021.54962.2882. PMID: 34692578; PMCID: PMC8507943.

Stefan L, Ericsson E. Health Benefits in a Cohort of Children 6 Months After Tonsil Surgery in Relation to the Perioperative Period: An Observational Prospective Cohort Study. Health Sci Rep. 2025 Jan 26;8(1):e70364. doi: 10.1002/hsr2.70364. PMID: 39877870; PMCID: PMC11773157. https://doi.org/10.1002/hsr2.70364

Anwaegbu OS, Clark DES, Iyamah SO, Ezenwukwa C, Etufugh UL, McKinnon BJ. Trends in postoperative complications following pediatric tonsillectomy & adenoidectomy: A 10-year analysis. Am J Otolaryngol. 2025 Sep-Oct;46(5):104712. doi: 10.1016/j.amjoto.2025.104712. Epub 2025 Jul 22. PMID: 40752357. https://doi.org/10.1016/j.amjoto.2025.104712

Francis DO, Fonnesbeck C, Sathe N, McPheeters M, Krishnaswami S, Chinnadurai S. Postoperative Bleeding and Associated Utilization following Tonsillectomy in Children. Otolaryngol Head Neck Surg. 2017 Mar;156(3):442-455. doi: 10.1177/0194599816683915. Epub 2017 Jan 17. PMID: 28094660; PMCID: PMC5639328. https://doi.org/10.1177/0194599816683915