Adenotonsillectomy in under-3s has low complication rate
MedWire News: Adenotonsillectomy has a very low complication rate in children aged 3 years and under, a US retrospective study has found.
Children in the current series were generally ready for discharge 6 hours after surgery, suggesting that the current routine practice of admitting children overnight may need to be reviewed.
"Criteria for inpatient admission for children younger than 3 years should be based on preoperative and postoperative clinical evaluation of the patient and an evaluation of the family resources for adequately caring for young children at home in the postoperative period," recommend study authors Dennis Spencer (The Rockefeller University, New York) and Jacqueline Jones (Weill Cornell Medical Center, New York).
Spencer and Jones reviewed medical records of 105 consecutive children aged 3 years and under, without a diagnosis of severe obstructive sleep apnea, who underwent adenotonsillectomy by a single surgeon over a 6-year period.
Records were incomplete for 19 children, leaving 86 children for analysis. The mean age at the time of surgery was 27.5 months (range 13-35 months) and 80 children (93.0%) experienced no complications whatsoever.
Children with complications ranged in age from 13 to 31 months. There were no severe complications, note the authors, and none of the complications arose in children who underwent microdebrider-aided procedures.
Of the six children with a complication, four became dehydrated on postoperative days 2-6, with boys and girls equally affected. One child developed reactive airway disease and one suffered postoperative fever, both of which were identified and treated in the postanesthesia care unit (PACU).
The average length of stay on the PACU was 152 minutes (range 60-360 minutes).
Discussing their findings, Spencer and Jones note that current US guidelines recommend that all children aged 3 years and undergoing tonsillectomy should be admitted overnight for postoperative observation.
However, the authors say that their experience "revealed that many children who were electively admitted overnight meet all the criteria to be discharged home within 6 hours of completion of their surgery and therefore perhaps did not require inpatient admission."
The present analysis confirms that the procedure is associated with a very low rate for complications and that complications, where present, are "generally mild and typically linked to dehydration."
The authors say that their current practice is to admit all children 24 months or younger and re-evaluate them 6 hours after admission for possible discharge. Meanwhile, children older than 24 months are scheduled for ambulatory admission and admitted only if complications arise.
Spencer and Jones write: "Careful selection of patients preoperatively, a dedicated pediatric team of nurses and anesthesiologists, and communication with families during the postoperative period have allowed us to more efficiently use our healthcare resources and provide young children with a more comfortable home setting for recovery after adenotonsillectomy."
By Joanna Lyford