Q:
My daughter is 24 yrs. old, overweight (228 pounds) and she smokes. She is otherwise in generally good health. She is going to need her tonsils out and I am very concerned if she would have greater risks. Also, I am very concerned about bleeding and blood clots after surgery. Would she be at greater risk for these?
A: Did you read my article on tonsillectomy/adenoidectomy for
obstructive sleep apnea? All of these risks apply to your
daughter. The fact that she is an adult means that she can
count on having much more post-op pain than would a child
(this is true of nearly every adult on whom I have done a
tonsillectomy). Sometimes, people are still taking a soft or
liquid diet 4 weeks after surgery! Quite a difference
relative to kids, who will often be back on a regular diet
within one week.
Lately, I've been performing intracapsular tonsillectomies on many of my adult patients. Intracapsular tonsillectomy uses a device known as a microdebrider to shave down the tonsil. In this procedure, the surgeon intentionally leaves behind a thin layer of tonsil tissue so as not to expose the throat muscles. The chief advantage of this procedure: it is less painful than a traditional tonsillectomy, and healing is faster. The only disadvantage: there is a small chance a tonsil might regrow -- 3% chance in the original study, 0.5% quoted in the above link. |
Post-operative hemorrhage (bleeding) is more common in adults than children.
The risks of anesthesia are greater for your daughter because of her weight and her smoking history. The more serious risks include pneumonia, blood clots in the legs or other parts of the body, heart attack, and stroke. These are not terribly common complications but they do occur more commonly in individuals who are older and/or less healthy. Your daughter needs to have a very thorough discussion with her anesthesiologist regarding these risks, just as she needs to have a similar discussion with her ENT regarding the risks of surgery.
Ultimately, the questions she needs to have answered to her satisfaction are:
Is surgery really the best treatment for my problem -- have all other reasonable alternatives been exhausted?
Do the risks of surgery (and general anesthesia) outweigh the benefits of surgery, or vice versa?
These are not questions I can answer for you. But, hopefully, I have outlined the issues in stark enough terms that she can now have a very pointed discussion with her doctors.