Safety of pediatric short-stay tonsillectomy

Objective: To determine the safety of a relatively brief (<3-hour) period o f postoperative observation prior to discharge in children undergoing outpa tient 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 tonsil lectomy or adenotonsillectomy from November 1995 through July 1997 were rev iewed. A total of 143 patients scheduled for ambulatory treatment were iden tified; 9 were excluded owing to insufficient followup. The remaining 134 p atients 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%. Ele ven (8.2%) of 134 planned outpatients were electively admitted from the rec overy room for inpatient observation, mast often because of respiratory com promise. Patients admitted from the recovery room were significantly younge r (mean age, 4.0 years) than those who were discharged as planned (6.3 year s, P<.001). One hundred twenty-three patients were discharged from the reco very room as anticipated, following a mean +/- SD duration of postoperative observation of 144 +/- 48 minutes. Overall, 5 (4.1%) of these 123 outpatie nts 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 dura tion of postoperative observation (P =.71). Conclusion: A short postoperative observation period is safe, with a low ra te of complications, in appropriately selected children scheduled for ambul atory tonsillectomy.