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Original Investigation |

Complications Following Inpatient Extracapsular Tonsillectomy in Children 36 Months and Younger

Johnathan E. Castaño, MD1; Monika E. Freiser, MD, MPH2; Hassan H. Ramadan, MD, MSc1
[+] Author Affiliations
1Department of Otolaryngology, West Virginia University, Morgantown
2Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
JAMA Otolaryngol Head Neck Surg. 2016;142(3):270-273. doi:10.1001/jamaoto.2015.3562.
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Importance  Tonsillectomy is among the most common surgical procedures performed by general and pediatric otolaryngologists. Inpatient surgery is generally recommended for children 36 months and younger owing to concern for a higher incidence of postoperative complications.

Objective  To ascertain the need for a planned inpatient stay for extracapsular tonsillectomy in children 36 months and younger.

Design, Setting, and Participants  Retrospective medical record review of patients 36 months and younger who underwent inpatient extracapsular tonsillectomy or adenotonsillectomy at a tertiary care academic institution from January 2009 to September 2014. Of 279 medical records reviewed, 188 met the inclusion criteria for the study.

Interventions  Extracapsular tonsillectomy.

Main Outcomes and Measures  Inpatient notes, discharge summaries, and postoperative clinic visit notes in the electronic medical record were reviewed for information about complications occurring during postoperative inpatient hospitalization. Specifically, the incidence of postoperative hemorrhage, postoperative pulmonary edema, oxygen desaturation to less than 90% requiring supplemental oxygen overnight, overall poor oral intake, poor oral intake leading to prolonged hospitalization exceeding 1 day, return to the operating room, and mortality were determined.

Results  The 188 patients in the study ranged in age from 18.3 to 35.9 months (mean, 29.5 months). Among the patients, 183 (97.3%) underwent surgery for sleep-disordered breathing, 2 (1.1%) were reintubated for postobstructive pulmonary edema, 1 (0.5%) experienced a self-limited postoperative hemorrhage, 5 (2.7%) required supplemental oxygen postoperatively, and 30 (15.9%) had poor oral intake postoperatively on the day of surgery. The hospital stay for 9 patients (4.8%) exceeded 1 day because of poor oral intake. No patients had to return to the operating room during their hospitalization and there were no deaths of patients in the population studied.

Conclusions and Relevance  Very few children experienced postoperative complications during their hospitalization, suggesting that outpatient tonsillectomy and adenotonsillectomy may be safe in children in this age group. Overnight hospitalization of children in this age group may not always be necessary after an appropriate period of postoperative observation.

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