Short Recovery Room Stay After Tonsillectomy Found Safe

LOS ANGELES, Nov. 20 -- After an outpatient tonsillectomy, most patients can go home safely within a couple of hours, according to researchers here.

"Every child and every situation needs to be taken on an individual basis," said Nina Shapiro, M.D., of Mattel Children's Hospital at the University of California at Los Angeles. "But, in general, we found that very short recovery room stays are safe."

Currently, Dr. Shapiro said in an interview, "there is no true standard of care" criteria for how long patients are observed after the procedure before being discharged. Every facility has different criteria.

She and colleagues noted that their institution had shorter recovery rooms stays, on average, than were being described in the medical literature and decided to see whether they had higher post-operative complication rates.

In fact, the complication rates were lower than those usually ascribed to the surgery, Dr. Shapiro and colleagues reported in the Nov. 29 issue of the International Journal of Pediatric Otorhinolaryngology.

The finding is part of a sea change in tonsillectomies over the past decade or so, Dr. Shapiro said. A combination of safer anesthetics, new non-sedating anti-emetics, and new surgical techniques has meant that the outpatient tonsillectomy is now standard.

(A recent study from the Mayo Clinic in Rochester, Minn., suggested that tonsillectomy be considered as a therapeutic option in children with recurrent strep throat, after a study showed the procedure reduced infection rates.)

But with more than half a million procedures performed every year in the U.S., the operation is still not completely standardized. "If you talk to 100 surgeons, you'll probably get 100 different techniques," Dr. Shapiro said.

The same is true for recovery room practices, she said.

The researchers examined 798 patient charts from January 1998, when the Mattel Children's Hospital began using the newer techniques, through June 2005. The study found:

• The average patient age was 6.8 years, with 53 patients under three, 655 aged from three to 12, and 89 patients from 12 to 21 years.
• The average recovery room observation time before discharge was 1.47 hours, but ranged from as short as 27 minutes to as long as seven hours and 15 minutes.
• The complication rate in the first 24 hours was 0.0075%.
• The rate after the first 24 hours was 0.0063%.
• All three age groups had much the same time in the recovery room and rates of post-op complications.

Dr. Shapiro said rates of complications ascribed to the outpatient surgery usually range from 1% to 6%.

The finding is good news for parents and children, she said. "It's always nicer to recover at home than in a hospital," Dr. Shapiro said.

But it may also be good news for medical facilities, because it can add "significant efficiencies" to the way care is delivered, she said.