Information for Physicians and their patients following subjects is available: Diabetes mellitus, Smoking Cesation, HIV/Aids, Childhood Obesity, Asthma, Vitamin D, Osteoporosis in People of Color, Cancer andDisparity Issues.

RACIAL, AGE, AND GENDER DISPARITIES IN THE INDICATIONS FOR TONSIL AND ADENOID SURGERY IN CHILDREN

 

Earl Harley, MD, FACS

Departments of Otolaryngology and Pediatrics

Georgetown University Hospital

Adedoyin Kalejaiye, MD, Resident, Georgetown University Hospital

Alexis Strohl, MS IV, Student, Georgetown University School of Medicine

 

Presented at the 2010 National medical Association meeting in Orlando, Florida

 

INTRODUCTION

Adenotonsillectomy is one of the most frequently performed operations in children.  

The most common indications for adenotonsillectomy can be classified into either obstruction or recurrent infection

Obstruction in these cases usually refers to sleep disordered breathing secondary to adenotonsillar hyperplasia and infection refers to recurrent tonsillitis.  

Despite how frequently these surgeries are performed, few studies have investigated racial and gender differences in indications  for children undergoing adenotonsillectomy

 

 

METHODS

IRB approved retrospective chart review  of 1,114  consecutive pediatric patients undergoing tonsillectomy or adenotonsillectomy at Georgetown University Hospital

Data were collected on each patient

Age : 1- 18  grouped  in 4 categories;   _<2,  3- 5, 6 -12, 13 - 18  

Reported Race: Black, White, Hispanic, Other

Indication for surgery: Obstruction, Infection, Obstruction and Infection, Other

Gender: Male, Female

Data were then analyzed in three separate groups: gender, race, and age in relation to indications for surgery

Individual Chi-Square tests performed on the data sets

Logistic regression was  used in the statistical analysis Logistic regression

 

RESULTS

There was no significant difference among genders in regards to indications for tonsillectomy/ adenotonsillectomy (p=.133).

Race

There were significant differences in regards to race and indication for surgery.  Black children were 4.15 times more likely than whites to have obstruction (CI 2.498-6.884, p=3.81x10-8) and Hispanic children were 4.39 times more likely than whites to have obstruction (CI 1.248-15.472, p=0.021).  There was no significant difference among the other races in comparison to white children (p=.582).

 

 

 

 

Age

When comparing age groups, there were only differences seen when comparing children ages 0-2 to ages 5-12 and 13-18. Children ages 0-2 were 4.364 times more likely than ages 5-12 to have obstruction (CI 1.678-11.353, p=2.53x10-3) and 27.73 times more likely to have obstruction than ages 13-18 (CI 9.187-83.66, p=3.73x10-9)

 

CONCLUSIONS

 

The most common indications for adenotonsillectomy is airway obstruction

Black children seem to be disproportionately affected by obstruction which is related to adenotonsillar hyperplasia

Younger children are also more likely than older children to undergo adenotonsillectomy for obstruction

Further studies would do well to investigate the impact of BMI in association with adenotonsillar hypertrophy  on sleep disordered breathing.

 

For more info email: earlharleymd@aol.com