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O U T P A T I E N T
E V O L U T I O N
CLINICAL EVIDENCE
Few Complications Following Adenotonsillectomy
A
denotonsillectomy can safely be
performed in young children with
minimal complications, so it's time
to start reevaluating the need for mandatory admission of all children younger than 3
years old, study results show.
DAY CARE Children who receive
For research published in the April 2012
expert perioperative care can be sent
home safely.
issue of JAMA Otolaryngology-Head &
Neck Surgery (tinyurl.com/p9jacpg), I reviewed the outcomes of 86 pediatric patients I operated on between January 2003 and October 2009 at
New York–Presbyterian Hospital, a tertiary care medical center in New
York City. There were minimal post-op complications, and notably no
respiratory issues — no one required intubation or significant supplemental oxygen. None of the patients had post-op problems that necessitated admission. Dehydration was the most common complication.
Recent studies, including mine, have proven the safety of outpatient
adenotonsillectomy, but the American Academy of Pediatrics and the
American Academy of Otolaryngology-Head and Neck Surgery hesitate
to issue national recommendations for sending all children home the
day of surgery. The groups must be certain the procedure can be completed safely in every type of facility, from my tertiary care facility in
New York City to community hospitals in the rural Midwest.
If more studies show that pediatric adenotonsillectomy patients can
be discharged safely, the AAO-HNS and AAP would feel more comfortable making recommendations stating physicians can use discretion in
deciding when patients can go home. In the meantime, rely on good
clinical sense when determining who can be discharged on the day of
— Jacqueline E. Jones, MD
surgery and who can't.