title: Postoperative Complications in Pediatric Tonsillectomy and Adenoidectomy in Ambulatory vs Inpatient Settings.
abstract: OBJECTIVE
  A large-scale review is needed to characterize the rates of airway, respiratory, and cardiovascular complications after pediatric tonsillectomy and adenoidectomy (T&A) for inpatient and ambulatory cohorts.
  
  
  OBJECTIVE
  To identify risk factors for postoperative complications stratified by age and operative facility type among children undergoing T&A.
  
  
  METHODS
  This retrospective review included 115,214 children undergoing T&A in hospitals, hospital-based facilities (HBF), and free-standing facilities (FSF) in California from January 1, 2005, to December 31, 2010. The analysis used the State of California Office of Statewide Health Planning and Development private inpatient data and Emergency Department and Ambulatory Surgery public data. Inpatient (n = 18,622) and ambulatory (n = 96,592) cohorts were identified by codes from the International Classification of Diseases, Ninth Revision, and Current Procedural Terminology. Data were collected from September 2011 to March 2012 and analyzed from March through May 2012.
  
  
  METHODS
  Rates of airway, respiratory, and cardiovascular complications.
  
  
  RESULTS
  A total of 18,622 inpatients (51% male; 49% female; mean age, 5.4 [range, 0-17] years) and 96,592 ambulatory patients (37% male; 35% female; 28%, masked; mean age, 7.6 [range, 0-17] years) underwent analysis. The ratio of ambulatory to inpatient procedures was 5:1. Inpatients demonstrated more comorbidities (≤8, compared with ≤4 for HBF and ≤3 for FSF patients) and, in general, their complication rates were 2 to 5 times higher (seen in 1% to 12% of patients) than those in HBFs (0.2% to 5%), and more than 10 times higher than those in the FSFs (0% to 0.38%), with rates varying markedly by age range and facility type. Tonsillectomy and adenoidectomy was associated with increased risk for all complication types in both settings, reaching an odds ratio of 8.5 (95% CI, 6.6-11.1) for respiratory complications in the ambulatory setting. Inpatients aged 0 to 9 years experienced higher rates of airway and respiratory complications, peaking at an odds ratio of 7.5 (95% CI, 3.1-18.2) for airway complications in the group aged 0 to 11 months.
  
  
  CONCLUSIONS
  Large numbers of pediatric patients undergo T&A in ambulatory settings despite higher rates of complications in younger patients and patients with more comorbidities. Fortunately, a high percentage of these patients has been appropriately triaged to the inpatient setting. Further research is needed to elucidate the subgroups that warrant postoperative hospitalization.
authors.affiliation: Department of Otolaryngology, Stanford University, Stanford, California.
authors.forename: Misha
authors.initials: M
authors.lastname: Amoils
authors.affiliation: Department of Otolaryngology, Stanford University, Stanford, California.
authors.forename: Kay W
authors.initials: KW
authors.lastname: Chang
authors.affiliation: Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, California.
authors.forename: Olga
authors.initials: O
authors.lastname: Saynina
authors.affiliation: Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, California.
authors.forename: Paul H
authors.initials: PH
authors.lastname: Wise
authors.affiliation: Department of Anesthesia, Stanford University, Stanford, California.
authors.forename: Anita
authors.initials: A
authors.lastname: Honkanen
mesh_terms: D000233:Adenoidectomy / Q000009:adverse effects*; D000293:Adolescent; D017677:Age Distribution; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects*; D002140:California / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007297:Inpatients; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D017678:Sex Distribution; D014068:Tonsillectomy / Q000009:adverse effects*