Peer-reviewed article

Do children with trisomy 21 have a greater risk of post-tonsillectomy sepsis?

Shayna Cooperman, Mai Thy Truong · 18 Sept 2026

Abstract

IMPORTANCE: Post-tonsillectomy sepsis is a rare but potentially life-threatening complication. Whether pediatric patients with Trisomy 21 are at increased risk compared with those without Trisomy 21 remains unclear. OBJECTIVE: To compare the incidence and risk of postoperative sepsis following tonsillectomy in pediatric patients with and without Trisomy 21. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study using a large de-identified national database containing insurance claims and electronic health records. Patients younger than 18 years who underwent tonsillectomy were identified using procedural codes. Patients with prior sepsis, immunodeficiency, or recent hospitalization were excluded. Patients with Trisomy 21 were compared with those without Trisomy 21. MAIN OUTCOMES AND MEASURES: The primary outcome was sepsis within 15 days of tonsillectomy. Secondary outcomes included postoperative infection. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. RESULTS: Among 148,376 pediatric patients who underwent tonsillectomy, 2161 had Trisomy 21. Patients with Trisomy 21 were older (mean age, 7.6 vs 6.2 years) and had a greater comorbidity burden than controls. Postoperative infection rates were similar between groups (OR, 0.80; 95% CI, 0.57-1.16). Sepsis occurred in 5 of 2161 patients with Trisomy 21 (0.23%) and 34 of 146,215 controls (0.02%). Trisomy 21 was associated with significantly greater odds of postoperative sepsis (OR, 9.97; 95% CI, 3.04-25.66). CONCLUSIONS AND RELEVANCE: Although overall postoperative infection rates were comparable, pediatric patients with Trisomy 21 had increased odds of postoperative sepsis following tonsillectomy. Further study is warranted to better characterize risk factors and potential preventive strategies.