Outpatient tonsilloadenoidectomy: avoiding complications

Especially during the last decade, tonsillectomy and adenoidectomy (T&A) have been performed increasingly in outpatient surgery facilities. Although complications following T&A are infrequent, they can be serious and have a precipitous onset. Hemorrhage and acute airway obstruction are among the most feared sequelae, and certain patterns have emerged depicting the circumstances under which these complications are more likely to happen. Other postoperative problems include fever, recurrent emesis, and poor oral fluid intake. To avoid unanticipated postoperative admissions, patients should be carefully selected and then observed for a minimum of 6 h following surgery. An individual with a history of obstructive sleep apnea is an inappropriate candidate for outpatient T&A. In addition, children younger than 3 yr are more likely to require postoperative hospitalization owing to such problems as respiratory distress and dehydration than older children.