title: Tracheal extubation practices following adenotonsillectomy in children: effects on operating room efficiency between two institutions.
abstract: BACKGROUND
  Adenotonsillectomy is one of the most commonly performed operative procedures in children. It is imperative to find the most efficient and cost-effective methods of practice to facilitate operating room management while maintaining patient safety. We investigated the efficiency of two different approaches of tracheal extubation in pediatric patients following adenotonsillectomy at two tertiary care pediatric hospitals with large surgical volumes. The primary aim of the study was to determine the difference in the operating room time according to the institutional practice of tracheal extubation in the postanesthesia care unit (PACU) as compared to the operating room.
  
  
  METHODS
  After obtaining IRB approval, a retrospective chart review was performed over a 12-month period at two large, tertiary care children's hospitals including the first hospital, where patients undergo tracheal extubation in the operating room after completion of the surgical procedure and a second hospital, where patients are brought directly to the PACU and undergo tracheal extubation in the PACU by nurses, with immediate availability of the pediatric anesthesiology faculty. Patients ≤12 years of age undergoing adenotonsillectomy were eligible for inclusion in the study. Patients with significant cardiopulmonary disease or scheduled for recovery in the critical care unit were excluded. Patient demographics, total time in the operating room, surgical time, total time in the PACU, and, when applicable, time until tracheal extubation, were noted.
  
  
  RESULTS
  The study cohort included 672 patients from the first hospital and 700 patients from the second hospital. Average operating room time was 17 min shorter at the first hospital than at the other, with most of the difference due to a reduction in the time between surgery end and transport from the operating room. PACU times were also 26 min shorter at the first hospital than at the second children's hospital.
  
  
  CONCLUSIONS
  Tracheal extubation in the PACU is an efficient use of operating room time and resources.
authors.affiliation: Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.|Department of Anesthesiology & Pain Medicine, The Ohio State University, Columbus, OH, USA.
authors.forename: Hiromi
authors.identifier: http://orcid.org/0000-0001-6502-3455
authors.initials: H
authors.lastname: Kako
authors.affiliation: Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.|Department of Anesthesiology & Pain Medicine, The Ohio State University, Columbus, OH, USA.
authors.forename: Marco
authors.initials: M
authors.lastname: Corridore
authors.affiliation: Department of Otolaryngology, Boston University Medical Center, Boston, MA, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Seo
authors.affiliation: Department of Otolaryngology and Head & Neck Surgery, Nationwide Children's Hospital and the Wexner Medical Center at Ohio State University, Columbus, OH, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Elmaraghy
authors.affiliation: Department of Otolaryngology and Head & Neck Surgery, Nationwide Children's Hospital and the Wexner Medical Center at Ohio State University, Columbus, OH, USA.
authors.forename: Meredith
authors.initials: M
authors.lastname: Lind
authors.affiliation: Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.|Department of Anesthesiology & Pain Medicine, The Ohio State University, Columbus, OH, USA.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tobias
mesh_terms: D000233:Adenoidectomy / Q000379:methods*; D000293:Adolescent; D060666:Airway Extubation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004526:Efficiency; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009873:Operating Rooms / Q000458:organization & administration*; D061646:Operative Time; D011997:Recovery Room / Q000458:organization & administration; D012189:Retrospective Studies; D013996:Time and Motion Studies; D014068:Tonsillectomy / Q000379:methods*
keywords: adenoidectomy; operating room efficiency; tonsillectomy; tracheal extubation