Investigation launched into death of two children after tonsil surgery

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Why is it that two children, entering hospital for a common surgery, ended up dying in the space of one month?

It’s a question worried parents are asking after Hamilton’s McMaster Children’s Hospital announced this week that tonsil and adenoid surgeries for children under 18 are being paused “out of an abundance of caution,” after two children died after being sent home following their surgeries. 

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In a statement, the hospital said that while there is no apparent connection between the two deaths, a “comprehensive review” is under way, and that only emergency surgeries will proceed until the review is complete. 

“There is obvious cause for concern when a relatively straightforward procedure results in two tragic outcomes so close together and it is certainly the responsibility and obligation of the hospital to investigate that,” said Sonia Nijjar, a Toronto medical malpractice lawyer. 

“We know from recent data that adverse events are more common than we think.” 

Hamilton Health Sciences, which oversees a network of hospitals in Hamilton, Ont., one child died the day after surgery. The second child passed away nine days after their initial surgery. “We want to extend our deepest condolences to these families,” the statement said. One death occurred in May, the other this month.

Tonsils are oval-shaped tissue located at the back of the throat. Adenoids are small lumps of tissue up behind the nose. 

They’re mainly removed because of recurring throat infections or, now more commonly, due to obstructive sleep apnea, a sleep-related breathing problem where people briefly stop breathing while they sleep. Large tonsils and adenoids can block the upper airways, interfering with breathing and leading to serious risks.

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Tonsillectomies are among the top surgeries performed in children, but are still considered major surgery, according to the Canadian Society of Otolaryngology-Head and Neck Surgery. 

The main risk of the surgery is bleeding — which can be serious. About five per cent of patients bleed post-surgery, which can require a second operation to stop the bleeding. Bleeds can occur in the first 24 hours after surgery but can occur up to two to three weeks later. 

Other complications include infections.

Surgery to remove the tonsils and adenoids is done under general anesthesia and usually takes from 45 to 60 minutes, according to a SickKids’ website. Most children are well enough to be sent home about six to eight hours after the operation. 

“These are very common surgeries and one of the oldest surgeries practiced for many years,” Dr. Sam Daniel, chief of surgery at Montreal Children’s Hospital, told CBC News Network. In Ontario, about 14,000 tonsillectomies are performed in children under 18 every year. 

One study of more than 504,000 children from five American states found that the rate of post-op death was seven per 100,000 tonsillectomies. The risk of death was highest in children with complex chronic conditions, such as neuromuscular or genetic disorders. 

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With regards to the Hamilton deaths, any investigation would look at “systems-level” factors, Nijjar said, such as staffing resources and infection control, as well as the surgeons, anesthetists and nurses involved. 

One parent wrote on X that his son had the same surgery in April and that complications started soon after surgery. “My son spent over 6 hours in an intensive care unit with oxygen. It was a very awful experience for my wife and I. I thank God he came out alive”

But another wrote that her son had the same surgery in March. “I believe the hospital acted with the utmost care for him and I am fully confident that this is nothing more than a freakish coincidence. (McMaster Children’s Hospital) is a world class institution and they should be praise for acting in an abundance of caution.”

Tonsillectomies are not recommended for children with uncomplicated throat infections if there have been fewer than seven episodes in the past year, five in each of the past two years or three episodes in each of the last three years, according to Choosing Wisely Canada, an organization that advocates against unnecessary surgeries and other medical procedures. “Families should be counselled on the limited benefits and potential harms of performing tonsillectomy for children and adolescents with low rates of recurrent infections.”

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When reached for comment, Hamilton Health Sciences referred National Post to its statement. Other children’s hospitals also declined to comment.

“While we understand there is much general interest in these surgical procedures at this time, we feel it would be most appropriate, helpful and reassuring for patients and families to speak directly with their care provider to address any specific questions and concerns they might have about an upcoming tonsil and adenoid surgery,” said a statement from London  Health Sciences Centre.

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