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Mortality and major morbidity after tonsillectomy

Etiologic Factors and Strategies for Prevention


  • This article was published online on April 17, 2013. An error was subsequently identified. This notice is included in the online and print versions to indicate that both have been corrected September 2013.

  • Presented at the Triological Society 115th Annual Meeting, San Diego, California, U.S.A., April 21, 2012.

  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Send correspondence to Michael J. Brenner, MD, Division of Otolaryngology, Department of Surgery, Southern Illinois University School of Medicine, PO Box 19649, Springfield, IL 62794-9649. E-mail: or



To report data on death or permanent disability after tonsillectomy.

Study Design

Electronic mail survey.


A 32-question survey was disseminated via the American Academy of Otolaryngology–Head and Neck Surgery electronic newsletter. Recipients were queried regarding adverse events after tonsillectomy, capturing demographic data, risk factors, and detailed descriptions. Events were classified using a hierarchical taxonomy.


A group of 552 respondents reported 51 instances of post-tonsillectomy mortality, and four instances of anoxic brain injury. These events occurred in 38 children (71%), 15 adults (25%), and two patients of unstated age (4%). The events were classified as related to medication (22%), pulmonary/cardiorespiratory factors (20%), hemorrhage (16%), perioperative events (7%), progression of underlying disease (5%), or unexplained (31%). Of unexplained events, all but one occurred outside the hospital. One or more comorbidities were identified in 58% of patients, most often neurologic impairment (24%), obesity (18%), or cardiopulmonary compromise (15%). A preoperative diagnosis of obstructive sleep apnea was not associated with increased risk of death or anoxic brain injury. Most events (55%) occurred within the first 2 postoperative days. Otolaryngologists who reported performing <200 tonsillectomies per year were more likely to report an event (P < .001).


This study, the largest collection of original reports of post-tonsillectomy mortality to date, found that events unrelated to bleeding accounted for a preponderance of deaths and anoxic brain injury. Further research is needed to establish best practices for patient admission, monitoring, and pain management. Laryngoscope, 123:2544–2553, 2013

Level of Evidence