Tonsillectomy and the Risk of Inflammatory Bowel Disease: A Retrospective Cohort Study Using Real-World US Data

<jats:title>Abstract</jats:title>
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<jats:title>Importance</jats:title>
<jats:p>Inflammatory bowel disease (IBD) encompasses chronic inflammatory conditions primarily affecting the small intestine and colon. Ulcerative colitis (UC) and Crohn’s disease (CD) involve dysregulated immune responses to intestinal microbiota, influenced by genetic predisposition, environmental factors, and gut barrier dysfunction. This retrospective cohort study was carried out to understand the relationship between immune-modulating surgeries like tonsillectomy and the development of IBD.</jats:p>
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<jats:title>Objective</jats:title>
<jats:p>To evaluate the association between tonsillectomy and the risk of developing IBD. Design, Setting, and Participants: This retrospective cohort study used the TriNetX research network, a large US-based collaborative platform, to identify 124,132,724 individuals from 2005 to 2023. After applying inclusion criteria, 1,420,302 matched participants (tonsillectomy vs nontonsillectomy) were selected using 1:1 propensity score matching.</jats:p>
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<jats:title>Exposure</jats:title>
<jats:p>Tonsillectomy.</jats:p>
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<jats:title>Main Outcome and Measure</jats:title>
<jats:p>The primary outcome was the incidence of IBD, including CD and UC, defined by validated diagnostic codes. Propensity score matching (PSM) (1:1) was used matching age, sex, race, body mass index, socioeconomic status, healthcare utilization, comorbidities, medications, and Creactive protein levels. Subgroup and sensitivity analyses were conducted to estimate the adjusted hazard ratio (HR) between surgical intervention and IBD risk.</jats:p>
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<jats:title>Results</jats:title>
<jats:p>After matching, baseline characteristics were well balanced between surgical and nonsurgical groups. Tonsillectomy was associated with a significantly increased risk of developing IBD (HR, 1.30; 95% CI, 1.14–1.47). Elevated risks were observed for both CD (HR, 1.37) and UC (HR, 1.29). Increased IBD risk was consistent across demographic subgroups. Sensitivity analyses confirmed the robustness of these findings across varying follow-up periods.</jats:p>
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<jats:title>Conclusions and Relevance</jats:title>
<jats:p>This study highlights a significant association between tonsillectomy and increased risk of developing IBD. These observations underscore the potential role of tonsillectomy in influencing long-term gastrointestinal health, warranting further investigation into underlying mechanisms and preventative strategies.</jats:p>
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