title: Is inpatient admission necessary following removal of airway foreign bodies?
abstract: OBJECTIVE
  To determine the need for postoperative admission following airway foreign body retrieval by examining the preoperative presentation, operative details, and postoperative recovery.
  
  
  BACKGROUND
  Inpatient admission following foreign body removal is common, however little evidence supports this practice. In the era of cost containment and prudent utilization of hospital resources, careful examination of the postoperative course following airway foreign body removal is required.
  
  
  METHODS
  A retrospective review of cases over a four year period from a pediatric tertiary care pediatric hospital was performed. All children presenting with concerns for airway foreign bodies were included. Children without identification of an airway foreign body during bronchoscopy were excluded. Microlaryngoscopy and bronchoscopy with airway foreign body extraction was performed. Details concerning demographics, operative findings, and pre and postoperative course including pulse oximetry were collected. All respiratory events, intubations, and persistent oxygen requirements were investigated.
  
  
  RESULTS
  Thirty five children underwent successful airway foreign body removal. The mean age was 3.2±2.6 years with a preponderance of males (68.6%). The retrieved items included: nuts (31.4%), popcorn (14.3%), seeds (8.6%), and inorganic materials (34.3%). Mean operative time was 29.7±25.6min. The mean length of stay following surgery was 1.3±1.9 days. Most patients (31/35) (88.6%) were extubated prior to transfer to recovery. 30/35 (85.7%) patients required no supplemental oxygen without desaturations following post anesthesia care unit (PACU) recovery. One patient developed laryngospasm requiring reintubation within 15min of surgery. Two patients were intubated prior to transfer for respiratory distress and remained intubated following surgery. Two patients breathing spontaneously prior to surgery were left intubated following surgery secondary to prolonged pneumonia treatment or multifocal foreign bodies with airway edema. All patients subsequently extubated without complication. In total, 30/31 (96.7%) of patients extubated in the operating room returned to room air oxygenation within 2h of surgery.
  
  
  CONCLUSIONS
  PACU observation and discharge is feasible in select children following airway foreign body extraction. Patients carefully monitored in the recovery unit without oxygen requirement are candidates for discharge. Inpatient monitoring is advised in 'children with preoperative respiratory distress or a complicated operative course.
authors.affiliation: Nemours Children's Specialty Care of Jacksonville Division of Pediatric Otolaryngology, Jacksonville, FL 32207 USA. Electronic address: steven.andreoli@nemours.org.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Andreoli
authors.affiliation: Children's Hospital of Philadelphia University of Pennsylvania, Perelman School of Medicine Department of Pediatric Otolaryngology Philadelphia, PA 19104 USA.
authors.forename: Emma
authors.initials: E
authors.lastname: Kofmehl
authors.affiliation: Children's Hospital of Philadelphia University of Pennsylvania, Perelman School of Medicine Department of Pediatric Otolaryngology Philadelphia, PA 19104 USA.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Sobol
mesh_terms: D060666:Airway Extubation; D001999:Bronchoscopy / Q000009:adverse effects; D002675:Child, Preschool; D005260:Female; D005547:Foreign Bodies / Q000175:diagnosis / Q000601:surgery*; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal; D007828:Laryngoscopy / Q000009:adverse effects; D008297:Male; D010102:Oxygen Inhalation Therapy; D011182:Postoperative Care; D012137:Respiratory System; D012189:Retrospective Studies
keywords: Airway foreign bodies; Bronchoesophagology; Inpatient admission