title: Prolonged recovery after out-patient pediatric adenotonsillectomy.
abstract: OBJECTIVE
  To determine variables predictive of recovery room times in pediatric outpatient adenotonsillectomy.
  
  
  METHODS
  Retrospective case-control.
  
  
  METHODS
  One-hundred ninety consecutive patients undergoing outpatient adenotonsillectomy at an ambulatory surgery center of a tertiary-care free standing pediatric hospital were grouped into upper and lower deciles of recovery room times. Twenty-one variables were analyzed to determine which variables are predictive of prolonged recovery time. Univariate and multivariate analyses were performed.
  
  
  RESULTS
  Of the 190 patients, mean recovery room time was 103 min (SD 53.1), 22 patients were in the lower decile (mean recovery room time of 63 ± 6 min) and 17 patients were in the upper decile (155 ± 40 min, P<0.0001). Of the 21 variables analyzed, post-anesthesia care unit (PACU) nursing staff was the only significant predictor of prolonged recovery room time. Compared with one PACU nurse, other nurses (N=5) predicted a longer recovery time (OR=10.8, 95% CI 2.0-59.5, P=0.0017). This association remained significant when controlling for anesthesiologist and surgeon (OR=8.8, 95% CI 1.5-50.9, P=0.0072). There were no complications in any patients.
  
  
  CONCLUSIONS
  Recovery room times after outpatient adenotonsillectomy vary significantly (mean 103 min (SD 53.1), range 50-241 min). Of potential predictors, only the human factor (PACU nursing staff) was associated with prolonged recovery room times, independent of surgeon and anesthesiologist. Development of standardized protocols for nurses to use for discharge has the potential to increase throughput for adenotonsillectomy patients in an outpatient surgery center setting.
authors.affiliation: Division of Otolaryngology, Children's National Medical Center, George Washington University School of Medicine, 111 Michigan Av NW, Washington, DC 20010, USA.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Jaryszak
authors.forename: Lina
authors.initials: L
authors.lastname: Lander
authors.forename: Anju K
authors.initials: AK
authors.lastname: Patel
authors.forename: Sukgi S
authors.initials: SS
authors.lastname: Choi
authors.forename: Rahul K
authors.initials: RK
authors.lastname: Shah
mesh_terms: D000233:Adenoidectomy / Q000009:adverse effects / Q000379:methods*; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D000704:Analysis of Variance; D000762:Anesthesia Recovery Period; D016022:Case-Control Studies; D002648:Child; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000639:trends*; D008297:Male; D015999:Multivariate Analysis; D010045:Outpatients / Q000706:statistics & numerical data; D010147:Pain Measurement; D011237:Predictive Value of Tests; D011997:Recovery Room / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014068:Tonsillectomy / Q000009:adverse effects / Q000379:methods*