Short-Stay Outpatient Tonsillectomy
Pamela J. Nicklaus, MD;
Fred S. Herzon, MD;
Ernest W. Steinle, IV, MS
Arch Otolaryngol Head Neck Surg. 1995;121(5):521-524.
Abstract
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Objective
To determine the risk of complications after discharge in outpatient adenotonsillectomy after a short (<6 hours) period of postoperative observation.
Design
Retrospective chart review.
Setting
Outpatient surgery center at a university hospital.
Patients
All patients 18 years of age or less who were scheduled for adenotonsillectomy or tonsillectomy from January 1988 through December 1991. Two hundred fifty-five patient records were reviewed. Twenty-two patients were excluded from the study because of various complicating medical conditions that required planned overnight hospitalization leaving a study population of 233 patients.
Main Outcome Measures
(1) Rate and type of complications; (2) duration of postoperative observation.
Results
Complication rates of bleeding, emesis, dehydration, and readmission were compared with rates deemed acceptable in the literature ( 10%). Power analysis demonstrated that the patient number was sufficient to establish a 95% confidence interval for a complication rate of 0% to 10%. The mean duration of postoperative observation was 136±48 minutes. Complications included bleeding, emesis, dehydration, and nonscheduled admissions. The total complication rate was 9% (95% confidence interval, 5.5% to 12.7%). The rate of primary bleeding was 1.4%, and all primary bleeding occurred within 75 minutes of arrival in the recovery room; no primary bleeding occurred after discharge from day surgery. This complication rate is comparable with rates previously described in the literature for patients who were observed for a 6- to 12-hour period.
Conclusion
The findings in this study suggest that short periods of observation are safe for outpatient pediatric patients undergoing adenotonsillectomy after discharge criteria are met.
(Arch Otolaryngol Head Neck Surg. 1995;121:521-524)
Author Affiliations
From the Division of Otolaryngology (Drs Nicklaus and Herzon) and the School of Medicine (Mr Steinle), University of New Mexico, Albuquerque.
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