Assess the rates of post-operative complications following tonsillectomy with/without adenoidectomy over a 10-year span, comparing young children and adolescents, while examining the influence of comorbidities, social determinants of health, and potential racial, and gender differences.

A retrospective cohort study using TriNetX database with de-identified electronic medical records from 57 healthcare organizations for ages 0–17 who had tonsillectomy with/without adenoidectomy from January 2014 to December 2023. Risk analysis and incidence proportion over a 10-year period for 5 outcomes occurring within 30 days, stratified by gender, race, and ethnicity. Then further subdivided into two groups: Early Childhood (0–9 years) and Adolescence (10–17 years). Statistical analysis included risk ratios (RR), and 95 confidence intervals (CI), with statistical significance set at p ≤ 0.05.

Before propensity score matching, 197,885 pediatric patients were identified. Most common complications occurring within 30 days were pain (3.1 %), post-operative hemorrhage (2.3 %) with 1.3 % requiring re-operation for control, dehydration (2.1 %), infection (0.26 %), and acute respiratory complications (0.21 %). Before propensity score matching, Early Childhood cohort (0–9 years: n = 71,024) and Adolescence cohort (10–17 years: n = 126,861). After propensity matching, n = 56,036 for both groups. Early Childhood cohort had higher rates for potential health hazards related to socioeconomic and psychosocial circumstances (p = 0.013) and environmental tobacco smoke exposure-related risks (p = 0.016) than Adolescence cohort. No significant differences in complication risks were observed between the two pediatric age groups.

Rates of dehydration and acute respiratory distress have declined, while post-operative hemorrhage, and pain have been increasing, and observable racial differences continue to persist within these complications.

Level of Evidence: III