Determining the optimal postoperative observation time for outpatient pediatric tonsillectomy

Evidence-based recommendations for the duration of postoperative monitoring for outpatient tonsillectomy are not established in the literature. This study aims to determine the safety of a 2-h postoperative observation time compared to a 3-h time.

We completed a prospective chart review of children between 3 and 18 years of age who underwent outpatient tonsillectomy with or without other procedures between August 2023 and February 2024 at a tertiary Children's Hospital. Patients were observed in the Post-Anesthesia Care Unit (PACU) and discharged following a 3-h institutionally required minimum observation period and meeting all discharge criteria. This observation period was compared to what length of stay (LOS) could have been if using a reduced 2-h-minimum period.

The sample consisted of 223 patients aged 3-18 years, with 50.7 % females. The average PACU LOS was 185.8 min. If the minimum-required observation time was reduced to 2 h, the average LOS could have been reduced to 143.84 min, saving 42.0 min on average per patient. No adverse events would have been missed if we had followed a 2-h minimum policy instead of the current 3-h policy. Older and female patients were more likely to meet all discharge criteria by 2 h (p < 0.05).

Adverse events after 2 h are rare following outpatient tonsillectomy, and these are unlikely to be missed if the observation time is reduced from 3 h to 2 h. These findings support the safety of a 2-h minimum observation period in addition to other clinical criteria.