Outpatient Safety for Pediatric Patients With Severe Obstructive Sleep Apnea Undergoing Adenotonsillectomy

Objective The objective of this study is to evaluate the admission guidelines and safety of outpatient tonsillectomy and adenoidectomy (T&A) for pediatric patients with severe obstructive sleep apnea (OSA).  Methods A retrospective chart review was performed by electronic medical record review. Eighty-seven pediatric patients (aged 3-17) were included; all underwent a T&A at a pediatric tertiary care center. All patients underwent polysomnography (PSG) to diagnose the presence and severity of OSA. After obtaining PSG results, these patients underwent T&A. The control group included admitted patients with an apnea-hypopnea index (AHI) of 10-20/hr, and the treatment group included discharged patients with an AHI of 10-20/hr. For the patients admitted, any oxygen desaturations overnight or oxygen supplementation required were documented. For all patients, return to the Emergency Department (ED) or an Urgent Care (UC) after discharge from the procedure was documented. A statistical analysis was then completed on the data. Results No respiratory-related events were documented for patients with an AHI less than 20/hr during overnight observation after T&A. Of the control group, only two were noted to have a desaturation event. None of the patients in the control group required supplemental oxygen overnight. Only one patient in this study required supplemental oxygen after a desaturation event, and their preoperative AHI was 46/hr. Three patients from the control group returned to the ED after discharge, and only two patients from the treatment group returned to the ED after discharge. However, none of the treatment group patients returned to the ED due to a respiratory-related event. Conclusion Current clinical practice guidelines in the United States recommend admission for pediatric patients with an AHI of ≥10 events per hour after T&A for OSA; however, this study provides support for the safe discharge of patients with an AHI less than 20 events per hour. This adjustment has the potential to decrease unnecessary hospital admissions, lower associated healthcare costs, and reduce the incidence of hospital-acquired complications. Given the retrospective, single-center cohort design of this study, larger multicenter prospective studies are warranted to further evaluate and validate these findings before changes to current clinical practice guidelines are considered.