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Postoperative Complications in Pediatric Tonsillectomy and Adenoidectomy in Ambulatory vs Inpatient Settings
Misha Amoils1, Kay W Chang1, Olga Saynina2
1Department of Otolaryngology, Stanford University, Stanford, California.
Insights
Pediatric tonsillectomy and adenoidectomy (T&A) shows higher complication rates in ambulatory settings, especially for younger children and those with comorbidities. Inpatient settings generally have lower complication rates for T&A procedures.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Health Services Research
Background:
- Tonsillectomy and adenoidectomy (T&A) are common pediatric procedures.
- Characterizing complication rates and risk factors is crucial for patient safety.
Purpose of the Study:
- To review complication rates after pediatric T&A in inpatient and ambulatory settings.
- To identify risk factors for postoperative complications, stratified by age and facility type.
Main Methods:
- Retrospective review of 115,214 pediatric T&A cases in California (2005-2010).
- Analysis of inpatient and ambulatory cohorts using state health data.
- Stratification by age, facility type (hospital, HBF, FSF), and comorbidities.
Main Results:
- Ambulatory T&A had a 5:1 ratio over inpatient procedures.
- Complication rates were 2-5 times higher in inpatients than HBFs and >10 times higher than FSFs.
- Younger inpatients (0-9 years) had higher airway/respiratory complication rates; ambulatory T&A showed an 8.5 OR for respiratory complications.
Conclusions:
- Pediatric T&A in ambulatory settings is frequent, but carries higher risks for younger, comorbid patients.
- Most patients are appropriately triaged, but further research is needed for optimal hospitalization decisions.
- Understanding risk factors is key to improving pediatric T&A safety.
Importance:
A large-scale review is needed to characterize the rates of airway, respiratory, and cardiovascular complications after pediatric tonsillectomy and adenoidectomy (T&A) for inpatient and ambulatory cohorts.
Objective:
To identify risk factors for postoperative complications stratified by age and operative facility type among children undergoing T&A.
Design, Setting, And Participants:
This retrospective review included 115,214 children undergoing T&A in hospitals, hospital-based facilities (HBF), and free-standing facilities (FSF) in California from January 1, 2005, to December 31, 2010. The analysis used the State of California Office of Statewide Health Planning and Development private inpatient data and Emergency Department and Ambulatory Surgery public data. Inpatient (n = 18,622) and ambulatory (n = 96,592) cohorts were identified by codes from the International Classification of Diseases, Ninth Revision, and Current Procedural Terminology. Data were collected from September 2011 to March 2012 and analyzed from March through May 2012.
Main Outcomes And Measures:
Rates of airway, respiratory, and cardiovascular complications.
Results:
A total of 18,622 inpatients (51% male; 49% female; mean age, 5.4 [range, 0-17] years) and 96,592 ambulatory patients (37% male; 35% female; 28%, masked; mean age, 7.6 [range, 0-17] years) underwent analysis. The ratio of ambulatory to inpatient procedures was 5:1. Inpatients demonstrated more comorbidities (≤8, compared with ≤4 for HBF and ≤3 for FSF patients) and, in general, their complication rates were 2 to 5 times higher (seen in 1% to 12% of patients) than those in HBFs (0.2% to 5%), and more than 10 times higher than those in the FSFs (0% to 0.38%), with rates varying markedly by age range and facility type. Tonsillectomy and adenoidectomy was associated with increased risk for all complication types in both settings, reaching an odds ratio of 8.5 (95% CI, 6.6-11.1) for respiratory complications in the ambulatory setting. Inpatients aged 0 to 9 years experienced higher rates of airway and respiratory complications, peaking at an odds ratio of 7.5 (95% CI, 3.1-18.2) for airway complications in the group aged 0 to 11 months.
Conclusions And Relevance:
Large numbers of pediatric patients undergo T&A in ambulatory settings despite higher rates of complications in younger patients and patients with more comorbidities. Fortunately, a high percentage of these patients has been appropriately triaged to the inpatient setting. Further research is needed to elucidate the subgroups that warrant postoperative hospitalization.
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