Association of Adenotonsillectomy with Vaso-occlusive Crisis Frequency in Sickle Cell Patients of Eastern Saudi Arabia: A Retrospective Study

Introduction: The Red Blood Cells (RBCs) in Sickle Cell Disease (SCD) are distorted into a crescent shape in conditions of low oxygen because of a mutant type of haemoglobin. Vasoocclusive Crisis (VOC), a defining symptom of SCD, is acute painful assaults caused by vaso-occlusion in the bone marrow. SCD is substantially more prevalent in some regions of Saudi Arabia than in others, with the Eastern Province having the highest incidence rates, followed by the Southern and Western provinces. A 90% of SCD patients were hospitalised due to a painful crisis, often brought on by several reasons, including infection, dehydration, acidosis, hypoxia and many others. Many childhood infections are linked to tonsil and adenoid infections, often requiring tonsillectomy or adenoidectomy. Aim: To evaluate the relationship between adenotonsillectomy and VOC frequency in SCD patients who underwent adenotonsillectomy. Materials and Methods: A retrospective cohort study was conducted in the Otorhinolaryngology Department in Qatif Central Hospital, Qatif, Saudi Arabia, in June 2023. Data were collected retrospectively from January 2019 and January 2022. Patients diagnosed with SCD and who underwent Adenoidectomy and/or Tonsillectomy was included in the study. Clinical and demographic data, along with co-morbidities and laboratory results, were retrieved from electronic medical records. Intragroup comparison of presurgical and postsurgical intervention variables was done using a paired t-test. A p-value of 0.05 or less was considered statistically significant. Results: A total of 32 patients were included in the study. Among the participants, females accounted for 13 (40.6%) and males accounted for 19 (59.4%) of cases. The mean age at surgery of the participants was 10.16 years. The mean of preadenotonsillectomy admissions was less than that of postadenotonsillectomy admissions in all periods; however, this difference was not statistically significant, with p-values of 0.156 for one year, 0.376 for two years and 0.162 for three years. The mean preadenotonsillectomy VOC was higher than the postadenotonsillectomy VOC for the one-year, two year and three-year periods, with p-values of 0.400, 0.167 and 0.088, respectively. Regarding Blood Transfusions (BT), the mean preadenotonsillectomy value was higher than the postadenotonsillectomy mean; however, this difference was not statistically significant, with a p-value of 0.395. Conclusion: Over three years, Adenotonsillectomy did not affect the frequency of VOCs, BTs and hospitalisations, indicating that these procedures may not be suitable as preventive measures for the majority of patients. Future research with larger sample sizes, preferably randomised controlled trials, is required to confirm the findings and assess whether performing the procedure prophylactically in SCD patients with recurrent tonsillitis lowers the frequency of VOCs, potentially reducing the number of ED visits for pain management and control.