Factors Associated With Revision Palatine Tonsillectomy in Pediatric Patients

IntroductionRevision tonsillectomy is uncommon but increasingly relevant as more surgeons adopt intracapsular techniques.As Current Procedural Terminology (CPT) coding does not allow for differentiation between intracapsular and extracapsular tonsillectomy, all pediatric cases must be considered collectively.We therefore aimed to explore whether demographic and/or clinical characteristics were associated with revision palatine tonsillectomy among children aged 17 years or younger, irrespective of surgical technique, to inform patient counseling. MethodsA retrospective cohort study was conducted using the PearlDiver Mariner database, a national claims database including approximately half of Americans across private and federally funded insurance carriers from 2010-2023.Pediatric patients undergoing palatine tonsillectomy were identified by CPT codes and divided into revision and no-revision cohorts.Revision was defined as a subsequent tonsillectomy code recorded at least 30 days after the initial procedure.Demographics, comorbidities, and care setting were compared, and multivariable logistic regression identified factors independently associated with revision.Secondary outcomes included revision rates by geographic region and care setting. ResultsOf 1,493,209 pediatric tonsillectomy patients, 3,660 (0.25%) underwent revision.Revision patients were younger (mean 5.0 vs 7.2 years, p<0.001) and more often male (54.5% vs 48.9%, p<0.001), although male sex was not independently associated with revision after adjustment (OR 1.03, 95% CI 0.97-1.10).On multivariable analysis, each additional year of age was associated with lower odds of revision (OR 0.80, 95% CI 0.79-0.81).Higher odds of revision were observed for patients with trisomy 21 (OR 2.08, 95% CI 1.49-2.91;revision rate 1.1%), obesity (OR 1.80, 95% CI 1.66-1.94),and lymphoproliferative disorders (OR 1.90, 95% CI 1.21-2.98).Revision rates were highest in the Northeast (0.38%) and after tonsillectomy performed in the inpatient setting (0.70%) compared with the outpatient setting (0.24%). ConclusionIn this large national cohort, revision tonsillectomy was rare.Younger age, obesity, trisomy 21, and lymphoproliferative disorders were independently associated with higher odds of revision, although absolute risk remained low in every subgroup.These findings may inform preoperative counseling.Whether these findings should alter surgical technique or perioperative management requires prospective study that distinguishes intracapsular from extracapsular techniques.