Comparison of high-versus low-dose corticosteroid administration on post-tonsillectomy outcomes

Objective: Intraoperative steroids have been shown to decrease post-tonsillectomy morbidity; however, optimal dosing of corticosteroids is unknown. This study evaluates the effects of high-versus low-dose dexemethasone administration (0.5 mg/kg vs. 0.1 mg/kg) on post-tonsillectomy outcomes.

Study design: Nonrandomized controlled study.

Setting: Academic Medical Center.

Methods: Pediatric patients undergoing tonsillectomy at the University of Michigan between 2017 and 2018 were identified. Uncomplicated patients between 1 and 18 years who received dexamethasone during their operation were included. Patients were categorized by high- or low-dose dexamethasone administration and outcomes assessed included revisits within 30 days for pain, vomiting/dehydration, and post-operative bleeding. The number of postoperative phone calls was also assessed.

Results: A total of 1641 patients were included in the study. No significant differences in steroid group outcomes were observed regarding vomiting (1.65% vs 1.7%, p = 0.618), bleeding (1.09% vs 1.3%, p = 0.579), pain (1.64% vs 0.62%, p = 0.141), other morbidities (3.83% vs 3.57%, p = 0.493) or post-operative phone calls (10.6% vs 9.9%, p = 0.81). Post-tonsillectomy bleeding was higher for infectious etiology versus sleep disordered breathing (p = 0.005); however, no rate differences for vomiting or pain were noted. Controlling for indication, no differences in hospital return rates were seen between steroid groups.

Conclusions: No statistically significant differences in post-tonsillectomy outcome measures were observed based on administration of either high- or low-dose dexamethasone. With no observed outcome differences related to steroid dosing, we transitioned to routine use of low-dose dexamethasone for tonsillectomy and adenoidectomy.