Adenoidectomy Alone Cuts Complications in Children’s Sleep Surgery Study

Children with sleep-disordered breathing who underwent adenoidectomy alone were far less likely to experience postoperative complications than those who had their tonsils removed, even though they needed repeat surgery more often, according to a retrospective cohort study from Tampere University Hospital in Finland. The findings, published in BMC Pediatrics, suggest that for appropriately selected children, the smaller operation can serve as an effective first-line treatment over long-term follow-up.

The research team reviewed the records of 1,065 children aged 0 to 16 years who visited the hospital between 2014 and 2018 with symptoms related to sleep-disordered breathing. Follow-up information on patient characteristics, treatments and the need for further surgery was collected through December 2023, giving a minimum observation period of five years and a median of 7.3 years. Of the children in the cohort, 85 percent were operated on initially.

The researchers compared three surgical approaches: adenoidectomy, in which only the adenoids are removed; adenotonsillectomy, which removes both adenoids and tonsils; and adenotonsillotomy, a partial reduction of the tonsils. Reoperation rates differed markedly between the procedures. Surgery had to be repeated in 16.5 percent of children after adenoidectomy, 9.6 percent after adenotonsillotomy, and just 1.8 percent after adenotonsillectomy, a difference that was statistically significant.

In multivariable analysis that accounted for other factors, both procedures involving the tonsils greatly reduced the likelihood of reoperation compared with adenoidectomy alone. Adenotonsillectomy carried an odds ratio of 0.16, and adenotonsillotomy an odds ratio of 0.53, meaning children who received these operations were substantially less likely to need a second surgery. Age also mattered: each increment in age decreased the likelihood of reoperation, with an odds ratio of 0.81, indicating that older children fared better with a single operation regardless of type.

However, the trade-off appeared in the complication data. The likelihood of any postoperative complication was significantly higher with adenotonsillectomy, which had an odds ratio of 9.05 compared with adenoidectomy, and with adenotonsillotomy, which had an odds ratio of 3.46. In practical terms, children whose tonsils were operated on faced roughly three to nine times higher odds of experiencing a complication during recovery than those whose surgery was limited to the adenoids.

Adenoidectomy is generally considered a smaller operation than tonsil-containing procedures. The study authors note that it may shorten recovery time, reduce operative risk, and result in lower health care costs compared with adenotonsillectomy. Isolated adenoidectomy is already recognized as a possible first-line treatment for pediatric sleep-disordered breathing in selected cases, and the new long-term data address whether it can be sufficient on its own.

The conclusion drawn by the team is that in most cases, isolated adenoidectomy is an effective treatment modality for appropriately selected children with sleep-disordered breathing when followed over the long term. Beyond the individual benefit of avoiding additional complications associated with tonsil surgery, the authors point to a significant opportunity to reduce the cost burden on the health care system and society, since the simpler procedure requires fewer resources per patient.

The results come with the limitations inherent to a retrospective design. The study drew on records from a single Finnish university hospital, and treatment decisions were made by clinicians rather than assigned randomly, so children selected for adenoidectomy may have differed systematically from those selected for more extensive surgery. The authors describe their cohort as involving appropriately selected cases, which means the favorable findings for adenoidectomy apply to children chosen for that procedure, not necessarily to all children with sleep-disordered breathing.

For clinicians weighing surgical options, the study quantifies the central dilemma: adenotonsillectomy offers the lowest reoperation rate by a wide margin, while adenoidectomy offers the lowest complication risk and presumably the fastest recovery. The choice between them depends on how the individual child’s anatomy and symptoms are assessed, and the long follow-up period of this cohort provides some of the strongest available evidence on how those decisions play out over years rather than months.

Subject of Research: Long-term outcomes of isolated adenoidectomy versus adenotonsillectomy and adenotonsillotomy in children with sleep-disordered breathing

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

Article References: Ruikka, E., Kivekäs, I., Ukonaho, L., Katila, M., Huhtala, H., & Markkanen, S. (2026). Is isolated adenoidectomy sufficient for pediatric sleep disordered breathing? A retrospective cohort study. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07842-y

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07842-y

Keywords: adenoidectomy, adenotonsillectomy, adenotonsillotomy, sleep-disordered breathing, pediatric surgery, reoperation, postoperative complications, retrospective cohort study, Tampere University Hospital, tonsillectomy, isolated, sufficient