Objectives:

Children with genetic syndromes, especially Down syndrome (DS), are considered high-risk candidates for adenotonsillectomy (AT) due to anatomical abnormalities and comorbidities. This study aimed to evaluate the safety of AT in patients with DS and other genetic syndromes (OS).

Methods:

This retrospective study included 62 syndromic patients (46 DS, 16 OS) under 18 years of age who underwent tonsillectomy ± adenoidectomy ± ventilation tube (VT) insertion between 2010 and 2025. Demographics, comorbidities, surgical details, complications, and hospital stays were reviewed.

Results:

Indications included sleep-disordered breathing (51/62, 82.3%) and recurrent tonsillitis (16/62, 25.8%). Procedures performed were AT (51/62, 82.3%) or tonsillectomy alone (11/62, 17.7%) ± VT insertion (16/62, 25.8%). Median hospital stay was 1 day (IQR: 1-1), with 93.5% (58/62) discharged after 1 day. Two-day stays occurred in 18.75% of OS patients (3/16) and 2.2% of DS patients (1/46). Planned intensive care unit admission was required in 2 OS patients (3.2%). No emergency admissions or perioperative mortality occurred. Overall complication rate was 8.1% (5/62)—8.7% in DS and 6.3% in OS (P = 1.00)—including bleeding requiring reoperation (1/62, 1.6%), respiratory event (1/62, 1.6%), and insufficient oral intake (3/62, 4.8%).

Conclusion:

AT appears to be safe in children with genetic syndromes, with low rates of complications.