Related Experiment Video
Updated: Mar 26, 2026
CO2-Lasertonsillotomy Under Local Anesthesia in Adults
Published on: November 6, 2019
Complications Following Inpatient Extracapsular Tonsillectomy in Children 36 Months and Younger
Johnathan E Castaño1, Monika E Freiser2, Hassan H Ramadan1
1Department of Otolaryngology, West Virginia University, Morgantown.
Insights
Outpatient tonsillectomy may be safe for children under 36 months, as few experienced complications. Overnight hospitalization may not always be necessary after this common pediatric surgery.
Area of Science:
- Pediatric Otolaryngology
- Surgical Outcomes
- Pediatric Anesthesia
Background:
- Tonsillectomy is a common procedure in children.
- Inpatient stays are standard for children 36 months and younger due to complication concerns.
Purpose of the Study:
- To evaluate the necessity of planned inpatient stays for extracapsular tonsillectomy in children 36 months and younger.
Main Methods:
- Retrospective review of 188 patients aged 18.3-35.9 months who underwent inpatient tonsillectomy or adenotonsillectomy.
- Complications assessed included hemorrhage, pulmonary edema, oxygen desaturation, and oral intake issues.
Main Results:
- Only 4.8% of patients had prolonged hospitalization due to poor oral intake.
- Postoperative complications like hemorrhage and pulmonary edema were rare (0.5% and 1.1% respectively).
- No patients required return to the operating room or experienced mortality.
Conclusions:
- The low incidence of complications suggests outpatient tonsillectomy may be safe for this age group.
- Overnight hospitalization may not be routinely required for children under 36 months post-tonsillectomy.
- Further research could support same-day discharge protocols for select pediatric patients.
Importance:
Tonsillectomy is among the most common surgical procedures performed by general and pediatric otolaryngologists. Inpatient surgery is generally recommended for children 36 months and younger owing to concern for a higher incidence of postoperative complications.
Objective:
To ascertain the need for a planned inpatient stay for extracapsular tonsillectomy in children 36 months and younger.
Design, Setting, And Participants:
Retrospective medical record review of patients 36 months and younger who underwent inpatient extracapsular tonsillectomy or adenotonsillectomy at a tertiary care academic institution from January 2009 to September 2014. Of 279 medical records reviewed, 188 met the inclusion criteria for the study.
Interventions:
Extracapsular tonsillectomy.
Main Outcomes And Measures:
Inpatient notes, discharge summaries, and postoperative clinic visit notes in the electronic medical record were reviewed for information about complications occurring during postoperative inpatient hospitalization. Specifically, the incidence of postoperative hemorrhage, postoperative pulmonary edema, oxygen desaturation to less than 90% requiring supplemental oxygen overnight, overall poor oral intake, poor oral intake leading to prolonged hospitalization exceeding 1 day, return to the operating room, and mortality were determined.
Results:
The 188 patients in the study ranged in age from 18.3 to 35.9 months (mean, 29.5 months). Among the patients, 183 (97.3%) underwent surgery for sleep-disordered breathing, 2 (1.1%) were reintubated for postobstructive pulmonary edema, 1 (0.5%) experienced a self-limited postoperative hemorrhage, 5 (2.7%) required supplemental oxygen postoperatively, and 30 (15.9%) had poor oral intake postoperatively on the day of surgery. The hospital stay for 9 patients (4.8%) exceeded 1 day because of poor oral intake. No patients had to return to the operating room during their hospitalization and there were no deaths of patients in the population studied.
Conclusions And Relevance:
Very few children experienced postoperative complications during their hospitalization, suggesting that outpatient tonsillectomy and adenotonsillectomy may be safe in children in this age group. Overnight hospitalization of children in this age group may not always be necessary after an appropriate period of postoperative observation.
Related Concept Videos
01:26Tonsillitis II: Management
01:30Tonsillitis I: Introduction
Etiology
Three primary contributing factors have been identified.
01:23Chronic Pharyngitis
Etiology
It often arises from persistent viral or bacterial infections affecting sinuses and tonsils.
Additional contributing factors include inadequate dental hygiene, mouth breathing, recurring tonsillitis, allergic rhinitis, laryngopharyngeal reflux, and exposure to smoke, chemicals, and other environmental pollutants. Allergic reactions to pollen, mold, and pet dander, chronic cough, excessive voice usage,...
01:29Suctioning the Nasopharyngeal Airway
Equipment Required
01:26Endoscopic Studies II: Thoracocentesis
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
01:25Suctioning the Oropharyngeal Airway
After assembling the equipment, the nurse should practice hand hygiene and don appropriate PPE according to infection control guidelines to avoid the...