Revisiting age-related admission following tonsillectomy in the pediatric population
Sean S Evans1, Do Yeon Cho1, Joshua Richman2
1The Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
Insights
A strict 36-month age cutoff for tonsillectomy admission did not significantly impact patient outcomes. Same-day discharge for children under three years old following tonsillectomy is also plausible, with no increased adverse events observed.
Area of Science:
- Otolaryngology
- Pediatric Surgery
Background:
- Tonsillectomy is a common pediatric surgical procedure.
- Age-based admission criteria and discharge protocols require careful evaluation for safety and efficacy.
Purpose of the Study:
- To assess patient outcomes using a strict 36-month age cutoff for tonsillectomy admission.
- To evaluate the safety and feasibility of same-day discharge for pediatric patients under 3 years old undergoing tonsillectomy.
Main Methods:
- Retrospective chart review of 427 patients aged 24-42 months undergoing tonsillectomy.
- Stratification into cohorts based on a 36-month age cutoff (<36 months vs. ≥36 months).
- Analysis of demographics, medical history, inpatient records, and 30-day post-operative outcomes (ED visits, readmissions).
Main Results:
- No significant differences in 30-day emergency department visits (3.0% vs. 3.7%), readmissions (1.0% vs. 1.8%), or length of stay were observed between age cohorts.
- Complication rates did not differ significantly based on age.
- The study supports the safety of the established age cutoff and suggests feasibility for same-day discharge in younger children.
Conclusions:
- A 36-month age cutoff for tonsillectomy admission at a tertiary center did not result in significant differences in adverse outcomes.
- Ongoing research into strict age-related admission criteria is warranted.
- Same-day discharge for younger children post-tonsillectomy appears safe and plausible.
Objectives/Hypothesis:
The objectives of this study were to examine patient outcomes using a 36-month age cutoff as a strict admission criterion following tonsillectomy, and review the safety and determine the plausibility of same-day discharge of children under 3 years old following tonsillectomy.
Study Design:
Retrospective chart review.
Methods:
A chart review of patients aged 24 to 42 months undergoing tonsillectomy over a 3-year period was conducted. Patients were stratified into <36 months and ≥ 36 months cohorts. Data collected included demographics, medical/sleep history, inpatient records, 30-day emergency department visits, and readmission data. Bivariate comparisons were made using χ2 and Wilcoxon tests for categorical and continuous variables.
Results:
Between July 2014 and July 2017, 427 patients aged 24 to 42 months underwent tonsillectomy at our institution. Thirty-day emergency department visit, readmission, and greater-than-expected length of stay rates were 3.0% versus 3.7% (P = .75), 1.0 versus 1.8% (P = .61), and 4.7% versus 4.5% (P = 1.00) between the younger and older cohorts, respectively, with no difference in complication rates identified based on age.
Conclusions:
No significant difference in adverse outcomes was appreciated based on a cutoff of 36 months of age at a tertiary center over 3 years. There should continue to be ongoing studies addressing strict age-related admission criteria.
Level Of Evidence:
4 Laryngoscope, 129:E389-E394, 2019.
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