Safety of pediatric short-stay tonsillectomy.

OBJECTIVE To determine the safety of a relatively brief (<3-hour) period of postoperative observation prior to discharge in children undergoing outpatient tonsillectomy. DESIGN Retrospective chart review. SETTING Tertiary care children's hospital and public teaching hospital. PATIENTS The records of all patients (12 years of age who underwent tonsillectomy or adenotonsillectomy from November 1995 through July 1997 were reviewed. A total of 143 patients scheduled for ambulatory treatment were identified; 9 were excluded owing to insufficient follow-up. The remaining 134 patients made up the study group. MAIN OUTCOME MEASURES (1) Duration of observation prior to discharge; (2) complication rates. RESULTS The mean age of the study population was 6.1+/-2.6 (mean+/-SD) years. Obstructive sleep apnea was an indication for surgery in 86.5%. Eleven (8.2%) of 134 planned outpatients were electively admitted from the recovery room for inpatient observation, most often because of respiratory compromise. Patients admitted from the recovery room were significantly younger (mean age, 4.0 years) than those who were discharged as planned (6.3 years, P<.001). One hundred twenty-three patients were discharged from the recovery room as anticipated, following a mean+/-SD duration of postoperative observation of 144+/-48 minutes. Overall, 5 (4.1%) of these 123 outpatients suffered complications after discharge. Two patients (1.6%) experienced primary bleeding, both at 8 hours after surgery. Four patients (3.2%) were readmitted. The complication rate did not vary significantly with the duration of postoperative observation (P= .71). CONCLUSION A short postoperative observation period is safe, with a low rate of complications, in appropriately selected children scheduled for ambulatory tonsillectomy.

[1]  D. E. Ross,et al.  Tonsillectomy performed on an outpatient basis. Report of a series of 40,000 cases performed without a death. , 1968, Archives of otolaryngology.

[2]  W. Crysdale,et al.  Complications of tonsillectomy and adenoidectomy in 9409 children observed overnight. , 1986, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[3]  S. Shott,et al.  Efficacy of tonsillectomy and adenoidectomy as an outpatient procedure: a preliminary report. , 1987, International journal of pediatric otorhinolaryngology.

[4]  D. E. Gebhart,et al.  Postoperative risks of pediatric tonsilloadenoidectomy , 1987, The Laryngoscope.

[5]  L Cozzi,et al.  Adenotonsillectomy: A Safe Outpatient Procedure , 1989 .

[6]  M. W. Wood,et al.  Safety of Outpatient Tonsillectomy and Adenoidectomy , 1990, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[7]  K. Mattucci,et al.  Tonsillectomy and adenoidectomy: An inpatient or outpatient procedure? , 1990 .

[8]  Colclasure Jb,et al.  Complications of outpatient tonsillectomy and adenoidectomy: a review of 3,340 cases. , 1990 .

[9]  J. Colclasure,et al.  Complications of outpatient tonsillectomy and adenoidectomy: a review of 3,340 cases. , 1990, Ear, nose, & throat journal.

[10]  B. Wiatrak,et al.  Complications of adenotonsillectomy in children under 3 years of age. , 1991, American journal of otolaryngology.

[11]  Same-day-stay adenotonsillectomy. , 1991, The Laryngoscope.

[12]  S. Handler,et al.  Is outpatient tonsillectomy appropriate for young children? , 1992, The Laryngoscope.

[13]  R. Naclerio,et al.  Respiratory compromise after adenotonsillectomy in children with obstructive sleep apnea. , 1992, Archives of otolaryngology--head & neck surgery.

[14]  M. Mahowald,et al.  Postoperative respiratory compromise in children with obstructive sleep apnea syndrome: can it be anticipated? , 1994, Pediatrics.

[15]  Short-stay outpatient tonsillectomy. , 1995, Archives of otolaryngology--head & neck surgery.

[16]  M. Setzen,et al.  Ambulatory Tonsillectomy and Adenoidectomy , 1996, The Laryngoscope.

[17]  Selected Risk Factors in Pediatric Adenotonsillectomy , 1997 .

[18]  Predictive factors for respiratory complications after tonsillectomy and adenoidectomy in children. , 1997 .

[19]  N. Friedman,et al.  Outpatient adenotonsillectomy. Is it safe in children younger than 3 years? , 1997, Archives of otolaryngology--head & neck surgery.