Is isolated adenoidectomy sufficient for pediatric sleep disordered breathing? A retrospective cohort study

Isolated adenoidectomy is a possible first line treatment for pediatric sleep-disordered breathing (SDB) in selected cases. It may shorten recovery time, reduce operative risk, and result in lower health care costs compared to adenotonsillectomy. This study evaluates whether isolated adenoidectomy can be sufficient treatment for children with SDB by comparing reoperation and complication rates with those of adenotonsillectomy and adenotonsillotomy. A retrospective cohort study of 1065 children aged 0-16 years who visited Tampere University Hospital between 2014 and 2018 with SDB-related symptoms. Information on patient characteristics, treatment modalities and outcomes, and the need for further treatment were collected through December 2023. Initially, 85% of the children were operated. The minimum follow-up period was 5 years (median 7.3 years). The reoperation rates were 16.5% after adenoidectomy, 9.6% after adenotonsillotomy, and 1.8% after adenotonsillectomy (p<.001). In multivariable analysis, increasing age decreased the likelihood of reoperation (OR 0.81, 0.73-0.92, p<.001). Compared to adenoidectomy, both adenotonsillectomy (OR 0.16, 95% CI, 0.06-0.44, p<.001) and adenotonsillotomy (OR 0.53, 95% CI, 0.30-0.95, p=0.032) greatly reduced the likelihood of reoperation. The likelihood of any postoperative complication occurring was higher with both adenotonsillectomy (OR 9.05, 95% CI, 3.49-23.45, p<.001) and adenotonsillotomy (OR 3.46, 95% CI, 1.23-9.73, p=0.019) than with adenoidectomy. In most cases, isolated adenoidectomy is an effective treatment modality for appropriately selected children with SDB in long-term follow-up. It presents a significant opportunity to avoid additional postoperative complications associated with tonsillectomy and tonsillotomy, while reducing the cost burden on the health care system and society.