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M. Lauren Lalakea, MD; Irene Marquez-Biggs, MD; Anna H. Messner, MD

Arch Otolaryngol Head Neck Surg. 1999;125:749-752.

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.

From the Divisions of Otolaryngology–Head and Neck Surgery, Santa Clara Valley Medical Center, San Jose, Calif (Dr Lalakea), Stanford University School of Medicine, Stanford, Calif (Drs Lalakea and Messner), and Lucile Salter Packard Children's Hospital at Stanford (Dr Messner), and the Department of Pediatrics, University of California at San Francisco (Dr Marquez-Biggs).

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