Postoperative Complications Following Tonsillectomy in Children with Ehlers-Danlos Syndrome

Sunday, October 12, 2025

2:54 PM - 3:00 PM EDT

Location: 233-234

Disclosure(s):

Murilo W. de Santana Hager, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Nicole M. Favre, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Ehlers-Danlos Syndrome (EDS) is an inherited collagen disorder marked by joint hypermobility, skin hyperextensibility, easy bruising, and abnormal scarring. This study assesses the risk of postoperative hemorrhage after adenotonsillectomy (TA) in pediatric patients with EDS compared to children without EDS.

Methods: A retrospective review between 2006 and 2024 was conducted on pediatric patients ( < 18 years) undergoing TA (CPT 42820, 42821, 42825, or 42826, SNOMED 173422009, ICD-10-OCS 0CTP), comparing those with and without EDS (ICD-10-CM Q79.6). Data were obtained from the TriNetX database, and propensity score matching ensured comparable groups. Power analysis determined that 425 patients were required to detect an effect size of 0.3 with 99% power. Outcomes included analgesic use, postoperative hemorrhage, and other complications within two weeks of surgery.

Results: A total of 243,056 children were identified, with 432 diagnosed with EDS. EDS patients were older than non-EDS patients (6.4 years, SD=3.6 vs. 5.5 years, SD=3.0, p<.001). After matching, both cohorts had a mean age of 6.4 years (SD=3.0). EDS patients were more likely to be prescribed NSAIDs (N=224, 51.9% vs. N=190, 44.0%, p=.021) and opioids (N=279, 64.6% vs. N=240, 55.6%, p=.007) for postoperative pain management. Postoperative hemorrhage (EDS: 6.3%, non-EDS: 5.3%), emergency department visits (EDS: 9.5%, non-EDS: 6.9%), and hospital readmissions (EDS: 3.7%, non-EDS: 2.3%) did not differ significantly between cohorts. However, symptoms concerning food and fluid intake (ICD-10-CM R63; 4.9% vs. 2.3%, p=.044) and nausea and vomiting (ICD-10-CM R11; 5.8% vs. 2.3%, p=.010) were more common in the EDS cohort.

Conclusions: While EDS is not associated with an increased risk of significant postoperative hemorrhage following TA, these patients are more likely to require additional pain management and experience gastrointestinal complications. These findings support the need for comprehensive pre-surgical evaluations, tailored postoperative care, and informed family counseling to optimize patient outcomes and resource utilization.

Presenting Author(s)

Murilo W. de Santana Hager, BS

Medical Student
Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
Buffalo, New York, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

MY

Mary Youssef, PharmD

Medical Student
Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
Buffalo, NY, United States

Disclosure information not submitted.
GV

Gaayathri Varavenkataraman, MA

Research Assistant
Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
East Amherst, New York, United States

Disclosure information not submitted.
SS

Shiven J. Sharma, JD

Medical Student
Icahn School of Medicine At Mount Sinai
New York, NY, United States

Disclosure information not submitted.
Nicole M. Favre, MD

Resident Physician
Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
Buffalo, New York, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Senior Author(s)

MC

Michele M. Carr, DDS MD PhD

Professor
Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
Williamsville, New York, United States

Disclosure information not submitted.