Pediatric Adenotonsillectomy over 20 Years in a High-Volume Italian Centre: Positive Outcomes with Low Complications – The Sassuolo Hospital Experience

BackgroundPediatric adenotonsillectomy is commonly performed for infectious and obstructive indications, but postoperative hemorrhage remains a concern. This study describes outcomes from a high-volume territorial network in southern Modena province, Italy.Methods: Retrospective observational study of 10,753 pediatric patients (aged 3–18 years) undergoing adenotonsillectomy at Sassuolo Hospital and affiliates (Vignola, Pavullo) from 2005–2024. Indications included recurrent tonsillitis (Paradise criteria), OSA (polysomnography-confirmed or clinical), and recurrent otitis media or otitis media with effusion (OME). Surgical techniques included curettage adenoidectomy and Colorado microdissection needle tonsillectomy. Primary outcomes were postoperative hemorrhage (overall and requiring revision), stratified by indication, age, and technique, compared descriptively with literature ranges. Secondary outcomes included pain (VAS scores), infection rates, and tissue regrowth. Data completeness was verified via electronic records (95.6%). Statistical analyses used descriptive statistics with 95% confidence intervals (95% CI) and χ² tests. Results: A total of 10,753 procedures were analyzed (4,325 tonsillectomies, 3,942 adenotonsillectomies, 2,486 adenoidectomies). Postoperative hemorrhage occurred in 202 patients (1.88%; 95% CI 1.64–2.15%); surgical revision was required in 75 (0.70%; 95% CI 0.56–0.87%), with multifactorial stratification showing higher risk for infectious indications (OR 1.41 vs OSA), younger age <5 years (OR 2.1), and tonsillectomy origin (OR 8.25 vs adenoidectomy); all rates at the lower end of literature ranges (2–5% and 0.9–2.5%, respectively; both p < 0.001 vs. literature means, χ² test). Mean VAS pain scores decreased from 3.2 (day 1) to 1.1 (day 7). No significant infections occurred; tissue regrowth rates aligned with literature (adenoidal 6–26%, tonsillar 5–10%). Conclusions: Sassuolo Hospital's experience highlights favorable postoperative outcomes and low complication rates in adenotonsillar surgery. Limitations include retrospective design and potential selection bias. Prospective studies are needed to confirm these findings.