The Impact of Adenotonsillectomy on Respiratory Tract Infections in Pediatric Patients: A Comparative Study Using a Korean Nationwide Population-Based Cohort

Background and Objectives: Although adenotonsillectomy (ATE) is widely accepted for obstructive sleep apnea and recurrent tonsillitis, its effectiveness in reducing respiratory tract infections (RTIs) remains a topic of debate. This nationwide population-based cohort study evaluated the association between ATE and the incidence of upper and lower RTIs in pediatric patients.Methods: Data were obtained from the Korean National Health Insurance Service sample cohort for 2010–2017. Children who underwent ATE were identified and matched with nonsurgical controls at a 1:5 ratio by age and sex. Hospital visits due to RTIs—including acute upper RTIs, influenza or pneumonia, and acute lower RTIs—were assessed from 1 year before surgery through 3 years after surgery. The odds of hospital visits were estimated using multivariable logistic regression, with odds ratios and 95% confidence intervals.Results: A total of 6,848 children who underwent ATE and 34,240 matched controls were included. Compared with the matched nonsurgical control group, the ATE group had higher odds of hospital visits due to upper and lower RTIs, whereas no significant difference was observed for pneumonia. Age-stratified analyses showed that lower RTIs increased first in younger children and later in older age groups during follow-up. Sex-stratified analyses showed increased lower RTIs in boys during postoperative years 1–2 and increased influenza or pneumonia in girls during postoperative years 2–3. Postoperative increases in RTIs were more pronounced among children without preoperative infection histories.Conclusion: ATE was not associated with fewer RTIs in pediatric patients. Instead, certain subgroups had a higher incidence of upper and lower RTIs after surgery. These findings suggest that ATE may have limited effectiveness in preventing RTIs and should not be performed solely for this purpose.