(1047) Optimizing Postoperative Observation of the Pediatric Tonsillectomy

Introduction: Clear evidence-based recommendations for the duration of postoperative monitoring for outpatient tonsillectomy are not outlined in the literature. The goal of this study is to determine the safety of a 2-hour postoperative observation time and the predictors of adverse events in the immediate postoperative period.

Methods: A prospective observational study of patients aged 3 to 18 years undergoing outpatient tonsillectomy at a tertiary children’s hospital from August 2023 to December 2023 was conducted. Patients with severe comorbidities or age below 3 requiring admission were excluded. Patients were observed in the Post-Anesthesia Care Unit (PACU) during an institutional 3-hour minimum observation period and until meeting strict discharge criteria including not requiring airway support, vital signs within 10% of baseline, and adequate oral intake and pain control. Outcomes measured included adverse events precluding discharge and the predictors of their occurrence. Independent variables included demographics, indication for surgery, and BMI class. Chi square test was used, and significance was set at p < 0.05.

Results: Of the 137 patients who underwent tonsillectomy, 49.9% of patients met discharge criteria by the 2-hour mark while 93.4% met criteria by the 3-hour mark. Most patients did not meet criteria by two hours due to inability to tolerate the minimum oral fluid requirement (67/70 patients). A total of 145 interventions were needed in the postoperative period including need for opiate pain control, oxygen supplementation, and antiemetic use; 99.3% of which occurred within 2 hours. Sex, age, sleep disorder, recurrent tonsillitis, tonsil size, concomitant procedures, BMI class, and Tylenol IV use were not significantly associated with timing of meeting discharge criteria.

Conclusions: Provided patients have met clinical indicators for discharge, the minimal postoperative observation period for outpatient tonsillectomy can be safely reduced to 2 hours, as patients are extremely unlikely to have any significant adverse events requiring intervention in the 3rd hour.