The Association of Steroids and Pediatric Post-Tonsillectomy Recovery: A Retrospective Review.

Objectives: Pain, dehydration, and bleeding remain significant concerns for pediatric tonsillectomy patients. The literature is sparse on potential effects of postoperative, outpatient steroid prescribing practices among the post-tonsillectomy pediatric population. We aim to investigate the association of a postoperative oral steroid course with pain, bleeding, and dehydration while controlling for infectious indication to guide physicians for appropriate management of this population. Methods: Single institution, retrospective review of pediatric patients aged 2-18 years who underwent tonsillectomy from 2019 to 2021. One group received a 4-dose course of postoperative oral dexamethasone, and the other did not. Among patients ages 2-6 and 7-18, the association of steroids with emergency department visits related to bleeding, dehydration, or uncontrolled pain was estimated while controlling for infectious indication and other factors. Results: There were 2054 pediatric tonsillectomy patients included. The majority were male (50.8%) and Non-Hispanic White (63.7%) with an average age of 7.0 years (SD = 3.9). About one-third (30.4%) of patients received dexamethasone, and dexamethasone was not associated with significantly lower odds of bleeding, dehydration, or uncontrolled pain/pain medication refills. Conclusion: A 4-dose course of postoperative dexamethasone was not associated with a significant reduction in post-tonsillectomy bleeding, dehydration, or pain when controlling for infectious indication. However, it may be reasonable as an adjunct therapy. Level of Evidence: 3.