Postoperative risks of pediatric tonsilloadenoidectomy.

Tonsilloadenoidectomy is performed over 340,000 times per year in the United States, usually as a same day admission procedure with a postoperative overnight stay. Because of the current emphasis on reducing health care costs, many insurers are requiring the procedure of tonsilloadenoidectomy be performed on an outpatient basis, even though there is a lack of data supporting the safety of such a requirement. The charts of 2,944 pediatric patients who underwent tonsillectomy and/or adenoidectomy from January 1, 1983 to December 31, 1984 were reviewed. Analyses revealed predictive variables that could be used to identify patients with a low risk of complications. Nineteen percent of the patients could be released 4 hours postoperatively with an 8.1% chance of subsequent complications. No patients who underwent the combined procedure of tonsillectomy and adenoidectomy were in this group. Of the remaining patients, 0.4% could be released 6 hours after surgery, or 85.9% could be released 8 hours after surgery, or 98.2% could be released 10 hours after surgery, all with a less than 10% chance of subsequent complications. This study supports keeping tonsilloadenoidectomy patients at least 8 hours and possible 10 hours after surgery to minimize the risk of complications after discharge.