Tonsillectomy Outcomes among Children with Mental Health Disorders in the United States

Objectives: Recent evidence suggests that children with mental health disorders are more likely to have postoperative complications. Our aim was to determine if mental health disorders affect postoperative complications after tonsillectomy with or without adenoidectomy (T&A). Setting: Cross-sectional analysis of national databases. Subjects and Methods: The 2006 to 2016 Kids Inpatient Database and the 2014 Nationwide Readmission Database were used to identify children (age <21 years) who underwent T&A. We compared children with mental health disorders (eg, autism, developmental delays, or mood disorders) to those without a mental health disorder. We contrasted gender, race, length of stay, complications, and 30-day readmissions. Results: We estimated that 37,386 children underwent T&A, and there were 2138 (5.7%) diagnosed with a mental health disorder. Children with mental health disorders were older (6.0 vs 5.3 years, P <.001), more commonly males (64% vs 58%, P <.001), had a longer length of stay (3.4 days vs 2.3 days, P <.001), and had higher total charges even after controlling for length of stay ($19,000 vs $14,000, P <.001). Children with a mental health disorder were more likely to have a complication (odds ratio [OR] = 2.1; 95% confidence interval [CI], 1.7 to 3.4; P <.001) including intubation, mechanical ventilation, or both (OR = 3.3; 95% CI, 2.6 to 3.8; P <.001). The 30-day all-cause readmission rate was higher (12% vs 4.0%, P <.001). Conclusion: Children with mental health disorders, especially development delays, have more frequent complications, longer lengths of stay, and readmissions than children without mental health disorders. This information should be included in preoperative counseling.