Nicklaus P J, Herzon F S, Steinle E W
Division of Otolaryngology, University of New Mexico, Albuquerque, USA.
Arch Otolaryngol Head Neck Surg. 1995 May;121(5):521-4. doi: 10.1001/archotol.1995.01890050019004.
To determine the risk of complications after discharge in outpatient adenotonsillectomy after a short (< 6 hours) period of postoperative observation.
Retrospective chart review.
Outpatient surgery center at a university hospital.
All patients 18 years of age or less who were scheduled for adenotonsillectomy or tonsillectomy from January 1988 through December 1991. Two hundred fifty-five patient records were reviewed. Twenty-two patients were excluded from the study because of various complicating medical conditions that required planned overnight hospitalization leaving a study population of 233 patients.
(1) Rate and type of complications; (2) duration of postoperative observation.
Complication rates of bleeding, emesis, dehydration, and readmission were compared with rates deemed acceptable in the literature (< or = 10%). Power analysis demonstrated that the patient number was sufficient to establish a 95% confidence interval for a complication rate of 0% to 10%. The mean duration of postoperative observation was 136 +/- 48 minutes. Complications included bleeding, emesis, dehydration, and nonscheduled admissions. The total complication rate was 9% (95% confidence interval, 5.5% to 12.7%). The rate of primary bleeding was 1.4%, and all primary bleeding occurred within 75 minutes of arrival in the recovery room; no primary bleeding occurred after discharge from day surgery. This complication rate is comparable with rates previously described in the literature for patients who were observed for a 6- to 12-hour period.
The findings in this study suggest that short periods of observation are safe for outpatient pediatric patients undergoing adenotonsillectomy after discharge criteria are met.
