European Archives of Oto-Rhino-Laryngology

, Volume 274, Issue 7, pp 2945–2951 | Cite as

Incidence of second surgery following pediatric adenotonsillar surgery: a population-based cohort study

  • Ola Sunnergren
  • Erik Odhagen
  • Joacim Stalfors


The aim of the study is to evaluate the incidence and risk factors of a second surgery of the adenoids or tonsils for hypertrophy in children who have already undergone surgery for the same condition. This is a retrospective study (2004–2013) based on data from the National patient registry in Sweden. A total of 41,401 children underwent a first surgery of the adenoids or tonsils during the studied period. The most commonly performed (first) surgical procedure was adenoidectomy followed by adenotonsillotomy, adenotonsillectomy, tonsillotomy, and tonsillectomy. A total of 4459 patients underwent a second surgery for the same condition. The incidence of a second surgery was the highest in the primary adenoidectomy group (72.2, 95% CI 69.7–74.7) and lowest in the primary adenotonsillectomy group (14.2, 95% CI 12.6–15.9). A lower age at first surgery significantly increased the risk for a second surgery. A second surgery of the adenoids and tonsils due to lymphoid hypertrophy was common in the pediatric population. Adenoidectomy stands out in a negative way in most aspects of this study compared to the other types of first surgery. However, due to the design of this study, the results of this study cannot be taken as proof of a full adenotonsillectomy as the most appropriate first surgery in children with lymphoid upper airway obstruction. Nevertheless, the results clearly show that the topic needs to be addressed in future studies.


Adenotonsillar surgery Secondary surgery Reoperation Tonsilletomy Adenoidectomy Tonsillotomy 



The authors acknowledge statisticians Bengt Bengtsson and Nils-Gunnar Pehrsson from Statistiska Konsultgruppen for performing statistical analysis.

Compliance with ethical standards

Conflict of interest

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

Ethical approval

The study was approved by the regional ethical review board in Linköping, Sweden (Dnr 2015/17–31).


  1. 1.
    Gerhardsson H, Stalfors J, Odhagen E, Sunnergren O (2016) Pediatric adenoid surgery in Sweden 2004–2013: incidence, indications and concomitant surgical procedures. Int J Pediatr Otorhinolaryngol 87:61–66CrossRefPubMedGoogle Scholar
  2. 2.
    Gysin C (2013) Indications of pediatric tonsillectomy. ORL J Otorhinolaryngol Relat Spec 75(3):193–202CrossRefPubMedGoogle Scholar
  3. 3.
    Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, Schechter MS, Sheldon SH, Spruyt K, Ward SD, Lehmann C, Shiffman RN, American Academy of Pediatrics (2012) Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 130(3):576–584CrossRefPubMedGoogle Scholar
  4. 4.
    Hultcrantz E, Ericsson E (2004) Pediatric tonsillotomy with the radiofrequency technique: less morbidity and pain. Laryngoscope 114(5):871–877CrossRefPubMedGoogle Scholar
  5. 5.
    Hultcrantz E, Ericsson E, Hemlin C, Hessén-Söderman AC, Roos K, Sunnergren O, Stalfors J (2013) Paradigm shift in Sweden from tonsillectomy to tonsillotomy for children with upper airway obstructive symptoms due to tonsillar hypertrophy. Eur Arch Otorhinolaryngol 270(9):2531–2536CrossRefPubMedGoogle Scholar
  6. 6.
    Odhagen E, Sunnergren O, Hemlin C, Hessén Söderman AC, Ericsson E, Stalfors J (2016) Risk of reoperation after tonsillotomy versus tonsillectomy: a population-based cohort study. Eur Arch Otorhinolaryngol 273(10):3263–3268CrossRefPubMedGoogle Scholar
  7. 7.
    Brietzke SE, Kenna M, Katz ES, Mitchell E, Roberson D (2006) Pediatric adenoidectomy: what is the effect of obstructive symptoms on the likelihood of future surgery? Int J Pediatr Otorhinolaryngol 70(8):1467–1472CrossRefPubMedGoogle Scholar
  8. 8.
    Dearking AC, Lahr BD, Kuchena A, Orvidas LJ (2012) Factors associated with revision adenoidectomy. Otolaryngol Head Neck Surg 146(6):984–990CrossRefPubMedGoogle Scholar
  9. 9.
    Kay DJ, Bryson PC, Casselbrant M (2005) Rates and risk factors for subsequent tonsillectomy after prior adenoidectomy: a regression analysis. Arch Otolaryngol Head Neck Surg 131(3):252–255CrossRefPubMedGoogle Scholar
  10. 10.
    Thomas K, Boeger D, Buentzel J, Esser D, Hoffmann K, Jecker P, Mueller A, Radtke G, Geißler K, Finkensieper M, Guntinas-Lichius O (2013) Pediatric adenoidectomy: a population-based regional study on epidemiology and outcome. Int J Pediatr Otorhinolaryngol 77(10):1716–1720CrossRefPubMedGoogle Scholar
  11. 11.
    Grindle CR, Murray RC, Chennupati SK, Barth PC, Reilly JS (2011) Incidence of revision adenoidectomy in children. Laryngoscope 121(10):2128–2130CrossRefPubMedGoogle Scholar
  12. 12.
    Monroy A, Behar P, Brodsky L (2008) Revision adenoidectomy–a retrospective study. Int J Pediatr Otorhinolaryngol 72(5):565–570CrossRefPubMedGoogle Scholar
  13. 13.
    Borgström A, Nerfeldt P, Friberg D, Sunnergren O, Stalfors J (2017) Trends and changes in paediatric tonsil surgery in Sweden 1987–2013: a population-based cohort study. BMJ Open 13;7(1):e013346CrossRefGoogle Scholar
  14. 14.
    Ericsson E, Brattwall M, Lundeberg S (2015) Swedish guidelines for the treatment of pain in tonsil surgery in pediatric patients up to 18 years. Int J Pediatr Otorhinolaryngol 79(4):443–450CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.Department of OtorhinolaryngologyRyhov County Hospital, County Council JönköpingJönköpingSweden
  2. 2.Department of OtorhinolaryngologySödra Älvsborgs HospitalBoråsSweden
  3. 3.Institute of Clinical SciencesSahlgrenska Academy at the University of GothenburgGothenburgSweden
  4. 4.Sheikh Khalifa Medical CityAjmanUnited Arab Emirates

Personalised recommendations