OBJECTIVE: To evaluate the level of evidence regarding the safety of outpatient pediatric tonsillectomy.
STUDY DESIGN AND SETTING: The medical literature addressing outpatient pediatric tonsillectomy was systematically reviewed. The level of evidence was assessed, and data were pooled.
RESULTS: Seventeen articles met inclusion criteria. Each article suggested that outpatient tonsillectomy was safe. The overall level of evidence was fair (grade B —). Pooled data analysis in the perioperative period showed a complication rate estimate of 8.8% (95% confidence interval [CI], 5.5%–12.1%; P ≤ 0.001) and an unplanned admission rate estimate of 8.0% (95% CI, 5.3%-10.7%; P ≤ 0.001). Subgroup analysis suggests that children under age 4 are at a higher risk of complications in the perioperative period with an odds ratio of 1.64 (95% CI, 1.16–2.31).
CONCLUSION: The level of evidence supporting the safety of outpatient pediatric tonsillectomy is fair. The analyzed data show a higher rate of early complications and unplanned admissions in children under age 4.
SIGNIFICANCE: The current evidence supports the practice of outpatient tonsillectomy in properly selected children.
EBM rating: A-1a
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References
1.
RossATKazahayaKTomLW. Revisiting outpatient tonsillectomy in young children. Otolaryngol Head Neck Surg2003;128:326–31. (Grade C)
2.
Tonsillectomy and adenoidectomy inpatient guidelines: Recommendations of the AAO-HNS Pediatric Otolaryngology Committee. AAOHNS Bull1996;Sept 13. (Grade C)
3.
GranellJGetePVillafruelaM. Safety of outpatient tonsillectomy in children: A review of 6 years in a tertiary hospital experience. Otolaryngol Head Neck Surg2004;131:383–7. (Grade C)
4.
RakoverYAlmogRRosenG. The risk of postoperative haemorrhage in tonsillectomy as an outpatient procedure in children. Int J Pediatr Otorhinolaryngol1997;41:29–36. (Grade C)
5.
MitchellRBPereiraKDFriedmanNR. Outpatient adenotonsillectomy. Is it safe in children younger than 3 years? Arch Otolaryngol Head Neck Surg1997;123:681–3. (Grade C)
6.
WiatrakBJMyerCM3rdAndrewsTM. Complications of adenotonsillectomy in children under 3 years of age. Am J Otolaryngol1991;12:170–2. (Grade B)
7.
SchlossMDTanAKSchlossB. Outpatient tonsillectomy and adenoidectomy: Complications and recommendations. Int J Pediatr Otorhinolaryngol1994;30:115–22. (Grade C)
8.
TanAKRothsteinJTewfikTL. Ambulatory tonsillectomy and adenoidectomy: Complications and associated factors. J Otolaryngol1993;22:442–6. (Grade C)
9.
KanervaMTarkkilaPPitkarantaA. Day-case tonsillectomy in children: Parental attitudes and consultation rates. Int J Pediatr Otorhinolaryngol2003;67:777–84. (Grade A)
10.
PostmaDSFolsomF. The case for an outpatient “approach” for all pediatric tonsillectomies and/or adenoidectomies: A 4-year review of 1419 cases at a community hospital. Otolaryngol Head Neck Surg2002;127:101–8. (Grade B)
11.
ShahCShahabRRobbP. Role of a home care team in paediatric day-case tonsillectomy. J Laryngol Otol2001;115:39–43. (Grade B)
12.
Rivas LacarteMP. Outpatient tonsillectomy: A prospective 7 years study—complications and comparison with inpatients. Ambul Surg1999;7:25–29. (Grade A)
13.
LalakeaMLMarquez-BiggsIMessnerAH. Safety of pediatric short-stay tonsillectomy. Arch Otolaryngol Head Neck Surg1999;125:749–52. (Grade B)
14.
HellierWPKnightJHernJ. Day case paediatric tonsillectomy: A review of three years experience in a dedicated day case unit. Clin Otolaryngol Allied Sci1999;24:208–12. (Grade B)
15.
GabalskiECMattucciKFSetzenM. Ambulatory tonsillectomy and adenoidectomy. Laryngoscope1996;106:77–80. (Grade A)
16.
NicklausPJHerzonFSSteinleEW4th. Short-stay outpatient tonsillectomy. Arch Otolaryngol Head Neck Surg1995;121:521–4. (Grade C)
17.
ChaplinJStevensonSStewartI. Paediatric day surgery adenotonsillectomy in New Zealand: A prospective study. Aust J Otolaryngol1995;2:11–15. (Grade A)
18.
MahadevanMBartleyJ. Paedeatric day case tonsillectomy: Early green lane experience. Aust J Otolaryngol1995;2:150–152. (Grade C)
19.
TruyEMeradFRobinP. Failures in outpatient tonsillectomy policy in children: A retrospective study in 311 children. Int J Pediatr Otorhinolaryngol1994;29:33–42. (Grade C)
20.
CarithersJSGebhartDEWlliamsJA. Postoperative risks of pediatric tonsilloadenoidectomy. Laryngoscope1987;97:422–9. (Grade C)
21.
SharpeD. Of apples and oranges, file drawers and garbage: Why validity issues in meta-analysis will not go away. Clin Psychol Rev1997;17:881–901. (Grade D)
