Pattern of Paediatric Adenoid and Tonsillar Surgery in Ekiti

Abstract

Background: Surgeries of adenoid, tonsils or both are common pediatric performed by otorhinolaryngologist, head, and neck surgeon worldwide. Clinical pattern and management varied in a different center. This study aimed at determining the rate, socio-demographic features, indications, barriers, types, complications and patients’ satisfaction with adenoid and tonsils surgery in low-income countries. Materials and Methods: This is a hospital-based retrospective study of pediatric patients who had adenotonsillectomy, adenoidectomy, and tonsillectomy in the study center. This study was carried out over a period of ten years from March 2007 to February 2017. Data for this study was obtained from the medical record department, ENT clinic operation booking register and theatre operation register. All the data obtained were statistically analyzed using SPSS version 16. The data were then expressed by descriptive statistics table, bar charts, and pie charts. Ethical clearance was sought for and obtained from the ethical committee of the institution. Results: A total of 463 patients were booked for adenoid and tonsillar surgery out of which 214 patients had surgery done during the study period. This represented 46.2% of the participants that had surgery done. Adenotonsillectomy peaked 38.3% at preschool age group: (1 - 5) years. There were 58.9% males and male to female ratio was 1.5:1. Majority 42.5% of the patients reside in the city while minority 25.7% of the patients were village dwellers. Preschool ages were the majority 40.2% while post-secondary schools ages were the minority 8.4% of the patients. The parents of the majority of the patients were 27.1% health workers and 24.8% business men, while the parent of the minority of the patients was 11.7% farmers and 16.4% industrial workers. Major indications for surgery were 52.3% obstructive sleep apnoea syndrome and 21.5% recurrent tonsillitis. Less common indications for surgery in this study were 1.4% persistent fever and 1.9% cardiopulmonary complications. There were 7.0% patients admitted as day cases and 93.0% patients admitted as an in-patient. Postoperatively, 1.4% of the day cases were admitted as inpatients while 1.9% of inpatients were treated as day cases. In this study, the established high risk factors include age less than 1 year 13.6%, Down syndrome 1.4%, craniofacial abnormalities 1.9%, malnutrition 10.7%, serum electrolyte and urea imbalance 10.3%, cardiovascular disease 3.7%, respiratory disease 7.5%, anaemia 8.9%, haemoglobinopathy 3.3% and coagulopathy 1.9%. There were no specific comorbidities that may likely influence the surgical outcome in majority 70.6% of the patients. Adenotonsillectomy was performed on 43.9% patients. Adenoidectomy only was performed on 24.8% patients. The proportion of adenoidectomy alone performed among the age group was 19.2% and 0.5% forages (1 - 5) and (16 - 18) years respectively. Conclusion: Adenoid and tonsils surgery are common pediatric otorhinolaryngologist surgical procedures faced with a different form of surgical barriers in low-income countries. These procedures were faced with a various form of risks and the cause of death in this study was cardiopulmonary complications.