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Ambulatory adenotonsillectomy in children less than 5 years of age
P L MacCallum1, D L MacRae, S Sukerman
1Department of Otolaryngology, University of Western Ontario, London.
Insights
Ambulatory adenotonsillectomy is safe for children under 5. Careful caretaker selection and day surgery support are crucial for successful early discharge after tonsillectomy.
Area of Science:
- Pediatric Surgery
- Otolaryngology
- Ambulatory Care
Background:
- Post-tonsillectomy monitoring is increasingly scrutinized.
- Safety concerns exist for ambulatory adenotonsillectomy in children under 5.
- Age alone was not a criterion for excluding day surgery at this institution.
Purpose of the Study:
- To evaluate the safety and outcomes of ambulatory adenotonsillectomy in children under 5 years of age.
- To assess admission and readmission rates for pediatric adenoidectomy and adenotonsillectomy.
- To identify factors influencing early discharge after day surgery.
Main Methods:
- Retrospective chart review of pediatric adenoidectomy and adenotonsillectomy cases.
- Data collected from 1995-1998 at London Health Sciences Centre.
- Analysis of patient demographics, surgical indications, PACU times, and admission reasons.
Main Results:
- 119 adenoidectomies and 278 adenotonsillectomies performed; average age 3 years.
- Common indications: obstruction (196) and infection (201).
- Unplanned admissions: 1% for hemorrhage, 14% for vomiting/dehydration; 0% readmission rate.
Conclusions:
- Ambulatory adenotonsillectomy is a safe procedure for children under 5.
- A reliable caretaker and day surgery support are vital for safe early discharge.
- Careful patient selection and post-operative support enhance safety in pediatric day surgery.
Objective:
Post-tonsillectomy monitoring has received a significant amount of attention in recent years. Although the literature questions the safety of ambulatory adenotonsillectomy in children less than 5 years of age, age alone did not exclude eligibility for day surgery at our institution.
Method:
A retrospective chart review was performed between 1995 and 1998 for all children who had undergone adenoidectomy or adenotonsillectomy at the London Health Sciences Centre in London, ON.
Results:
There were 119 adenoidectomies and 278 adenotonsillectomies performed. The average age was 3 years at the time of surgery. One hundred and ninety-six cases were performed for obstruction, and 201 were done for infection. Average time spent in the postanaesthesia care unit was 6 hours for adenotonsillectomy and 4.5 hours for adenoidectomy. There were 26 planned and 60 unplanned admissions. One (4/397) percent of the unplanned admissions were for postoperative hemorrhage; 14% (56/397) were for vomiting and dehydration. No cases were admitted for postoperative desaturations or hypotensive episodes. The readmission rate was 0%.
Conclusions:
Ambulatory adenotonsillectomy is a safe procedure in children less than 5 years old. However, a well-informed, reliable caretaker and support from the day surgery staff is essential in early discharge of young patients after adenotonsillectomy.
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