Acute Kidney Injury (AKI) After Pediatric Tonsillectomy: An Opportunity for Quality Improvement.

Abstract

Purpose: There is emerging evidence showing even a single episode of transient acute kidney injury (AKI) in children can have negative long-term health consequences. AKI may be under-recognized in children undergoing tonsillectomy because of unique risk factors, such as recommended use of NSAIDs and restricted oral intake pre- and postoperatively.

Methods: A consecutive case series with chart review was performed for patients under age 18 years at a single tertiary care institution who underwent tonsillectomy between July 1, 2013 and May 17, 2024, identified by CPT codes for tonsillectomy. ED visits within 30 days of surgery were documented. Serum creatinine values at ED visit were recorded, if available, and incidence of elevated serum creatinine and AKI were determined.

Results: Charts of 3018 pediatric tonsillectomy patients were reviewed. About 295 (9.8% of 3018) had an ED visit within 30 days for any reason, of whom 110 (37.3% of 295) had a serum creatinine value at this ED visit. Of these, 13 (11.8% of 110) had elevated serum creatinine, and 8 (7.3% of 110) had AKI by standardized criteria. One patient had a follow-up serum creatinine performed within 1 year which showed resolution of AKI.

Conclusion: Incidence of AKI following tonsillectomy has not been previously well recognized. Identification of previously unrecognized risks from post-tonsillectomy AKI represents an important potential area for quality improvement, including careful patient selection for use of non-steroidal anti-inflammatory drugs, close monitoring of those at higher risk for dehydration after surgery, and follow-up care for those diagnosed with AKI.