An analysis of factors influencing postanesthesia recovery after pediatric ambulatory tonsillectomy and adenoidectomy.
BACKGROUND
Many factors contribute to prolonged length of stay (LOS) for pediatric patients in the postanesthesia care unit (PACU). We designed this prospective study to identify the pre- and postoperative factors that prolong LOS.


METHODS
We studied 166 children, aged 1-18 yr, who underwent tonsillectomy and adenoidectomy or tonsillectomy and adenoidectomy, and bilateral myringotomy with tube insertion under general anesthesia. The primary outcome measure was the time spent in the PACU until predetermined discharge criteria were met.


RESULTS
The number of episodes of postoperative nausea and vomiting, patient age, and number of oxygen desaturations contributed significantly (P < 0.05) to prolonged LOS. Each episode of postoperative nausea and vomiting (P < 0.05) or oxygen desaturation to <95% (P < 0.05) increased the patient's LOS by 0.5 h. History of upper respiratory tract infection, emergence agitation, and parental anxiety did not significantly predict increased LOS.


CONCLUSIONS
This investigation is the first composite view of LOS in pediatric patients. The significance of identifying patients at risk of prolonged LOS prior to anesthesia is of use not only in allocating PACU resource and staffing needs, but also for improving quality of care and ensuring a minimally traumatic anesthetic experience for our pediatric patients and their families.
Edler
Alice A
AA
Department of Anesthesia, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, California 94305, USA. edlera@aol.com
Mariano
Edward R
ER
Golianu
Brenda
B
Kuan
Calvin
C
Pentcheva
Krassimira
K
D000233:Adenoidectomy / Q000706:statistics & numerical data; D000293:Adolescent; D000367:Age Factors; D000556:Ambulatory Surgical Procedures / Q000706:statistics & numerical data; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General / Q000706:statistics & numerical data*; D002140:California / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005163:Factor Analysis, Statistical; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D016017:Odds Ratio; D010100:Oxygen / Q000097:blood; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011997:Recovery Room / Q000706:statistics & numerical data; D018570:Risk Assessment; D012307:Risk Factors; D014068:Tonsillectomy / Q000706:statistics & numerical data; D014432:Tympanic Membrane / Q000601:surgery
D010100:Oxygen