Identification of High-risk Tonsillectomy and Adenoidectomy

Abstract

Objective: To identify children who were at risk to postoperative complications after tonsillectomy and/or adenoidectomy, and to propose a guideline for care giving of this group of patients.
Methods: Retrospective chart study of children who underwent tonsillectomy and/or adenoidectomy and required special postoperative care was performed from August 1999 to March 2005. All children were treated under supervision of the authors at the Department of Otolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University.
Results: One hundred and twenty-nine children were operated during the study period. One hundred and twenty-three charts were retrievable. Forty-seven children were included in the series. Four categories of patients, i.e., very young-age group, intensive care unit group, extended admission group, and postoperative bleeding group, were identified. Eleven children (23.4%) whose ages were less than 36 months were observed in post-anesthetic recovery unit (PACU) for 5-6 hours with oxygen saturation monitoring and oxygen supplementation. Fourteen children (29.8%) were admitted to pediatric intensive care unit (PICU) with the most common indication of morbid obesity (64.3%). Four children needed interventions, which were two intravenous dexamethasone injections and two temporary continuous positive airway pressure (CPAP) administrations in PICU. Twenty children (42.6%) had extended admission because of postoperative fever and inadequate oral intake. However, every one of them improved within 48 hours postoperatively. Two children (4.2%) had minor postoperative bleeding and one of them needed bleeding control.
Conclusion: Tonsillectomy and adenoidectomy are procedures of low morbidity in healthy children. However, very young patients and those with high-risk of co-morbidities are considered to have high chance of compromised airway and inadequate oral intake. Besides our routine admission, we suggest that children under the age of 36 months need close observation for 5-6 hours in PACU. Admission in PICU is probably necessary for children who have high-risk of co-morbidities such as morbid obesity, asthma, cardiac diseases, neuromuscular disorders, craniofacial anomalies. Adequate oral intake is needed before removing intravenous fluid line and a consideration of discharge. Extended admission is unnecessary for postoperative fever, which mostly disappears within 48 hours.