The Case for an Outpatient “Approach” for All Pediatric Tonsillectomies and/or Adenoidectomies: A 4‐Year Review of 1419 Cases at a Community Hospital

Abstract

Children less than 3 years of age require more careful observation, especially after tonsillectomy and more likely will need to be observed overnight than older children.

Outcomes of reduced postoperative stay following outpatient pediatric tonsillectomy

“…Absence of oral intake requirement may have contributed to our reduced observation times. Complication rates in the present study were lower than those reported in other studies, which range from 0.8% to 6% [8,[12][13][14][15]. Since all procedures were performed in a tertiary care outpatient facility in a large metropolitan area, it is possible that some patients who lived outside of the hospital environs may have sought treatment at outside facilities for postoperative complications, which were not recorded in our medical record system.…”

Day stay pediatric tonsillectomy—a safe procedure

“…Literature reviews suggest primary hemorrhage rates of 1-3% and secondary hemorrhage rates of 0.15-6.4% [26,27] Most series are small and depend on the definition of hemorrhage [28,29]. Reported primary postoperative bleeding rates for day stay tonsillectomy vary--0.6% (n = 593) [17], 1.4% (n = 233) [21], 1.6% (n = 134) [19], 3.1% (n = 320) [22], 3.5% (n = 452) [8]. Our postoperative hemorrhage rates are similar to those of Crysdale et al [5] who reported a post-tonsillectomy hemorrhage rate of 2.15% (CI 1.85-2.44) for children admitted overnight into a major North American teaching hospital (n = 9409).…”

“…Kendrick and Gibbin [12] report a major hemorrhage incidence of 0.7% (n = 413). Although day stay tonsillectomy remains controversial in parts of Europe [11][12][13][14][15][16], experience has been gained in North America [7,8,[17][18][19][20][21][22][23][24][25]. Literature reviews suggest primary hemorrhage rates of 1-3% and secondary hemorrhage rates of 0.15-6.4% [26,27] Most series are small and depend on the definition of hemorrhage [28,29].…”

Sonographic measurement of palatine tonsil volume in children and comparison with actual volume

“…The incidence of postoperative complications, especially in children younger than 3 years, is nearly four times higher [18]. Additionally, sonography may be used to predict which children may develop more postoperative complications after tonsillectomy in tonsillar hypertrophy and severe OSAS cases.…”