Ambulatory pediatric otolaryngologic procedures in the United States: characteristics and perioperative safety

Abstract

Objectives/hypothesis: Determine the prevalence and safety of pediatric ambulatory otolaryngologic procedures in the United States.

Study design: Historical cohort study.

Methods: All cases of pediatric otolaryngologic surgery were extracted from the National Survey of Ambulatory Surgery 2006 release. The population was characterized according to age, sex, and individual procedures performed. Rates of immediate perioperative complications were determined for arrest, malignant hyperthermia, hemorrhage, blood transfusion, and postoperative nausea/vomiting. Discharge status and unexpected medical return visits were tabulated. Complication rates for patients younger than 3 years were compared to the remaining cohort.

Results: An estimated 1,410,546 +/- 246,009 (+/- standard error) children underwent one or more pediatric otolaryngologic procedures in 2006 (mean age, 6.23 +/- 0.19 years; 50.9% +/- 2.2% male). The most common primary procedures performed were myringotomy and tube (551,222 cases), tonsillectomy with adenoidectomy (480,343 cases), adenoidectomy (81,048 cases), tonsillectomy (56,606 cases), myringotomy alone (27,691 cases), tympanostomy tube removal (21,446 cases), and close reduction of nasal fracture (15,230 cases). There were no reported cases of cardiac arrest, malignant hyperthermia, or blood transfusion. Postoperative nausea, vomiting, and perioperative bleeding occurred in 1.4%, 0.9%, and 0.2% of cases, respectively. Children younger than 4 years undergoing tonsillectomy were more likely to return to the surgery center (2.5%, P < .001) or have an unplanned admission (9.28%, P = .011) than older children.

Conclusions: Pediatric otolaryngologic surgery is not only common but very safe in the ambulatory setting, with relatively minor complications occurring at rates of approximating 1%. Life-threatening complications are exceedingly rare. Ambulatory tonsillectomy in children younger than 4 years requires careful selection.