Re-Evaluating the Safety and Efficacy of Universal Post-Operative Admission in Tonsillectomies in Children Under the Age of Three.

Abstract

Background: Adenotonsillectomy (T&A) is a common outpatient procedure for children, yet the necessity for inpatient observation in children aged 2-3 years is debated and pursued out of caution. This study evaluates complications and readmissions post-T&A in children 2-3 years at a high-volume, single-center outpatient surgical facility.

Methods: A retrospective cohort study was conducted identifying 410 patients aged 2-3 years who underwent T&A between October 1, 2018, and May 31, 2023. Patients were identified using CPT codes, and data on complications and unscheduled readmissions were collected. Complications were categorized and analyzed. Additionally, a literature review was performed to compare complication rates with existing studies on T&A in children.

Results: Of the 410 patients, 7.32% re-presented for care postoperatively. The most common complications were dehydration or poor oral intake (3.41%) and fever/viral/bacterial infections (3.17%). The mean time to complication presentation was 4.83 days (SD ± 3.20). Six patients (1.46%) required readmission, primarily for additional medical intervention (4 cases) and observation (2 cases). Re-presentations necessitating intervention were low (5.12%), typically requiring brief treatments such as intravenous fluids or medication adjustments.

Conclusion: This study suggests that routine inpatient observation for children aged 2-3 years post-T&A may not be necessary in the absence of other risk factors as complications requiring significant intervention are not increased in the outpatient setting for this age-group. These findings align with emerging literature, supporting outpatient management for this age group under specific conditions. Further research may solidify updated criteria for safe outpatient procedures, optimizing healthcare resource utilization and patient outcomes.