Outpatient tonsillectomy in children: A systematic review
Presented at the 2005 Annual Meeting of the American Academy of Otolaryngology–Head and Neck Surgery, Los Angeles, CA, September 25-28.
Objective
To evaluate the level of evidence regarding the safety of outpatient pediatric tonsillectomy.
Study design and setting
The medical literature addressing outpatient pediatric tonsillectomy was systematically reviewed. The level of evidence was assessed, and data were pooled.
Results
Seventeen articles met inclusion criteria. Each article suggested that outpatient tonsillectomy was safe. The overall level of evidence was fair (grade B−). Pooled data analysis in the perioperative period showed a complication rate estimate of 8.8% (95% confidence interval [CI], 5.5%-12.1%; P ≤ 0.001) and an unplanned admission rate estimate of 8.0% (95% CI, 5.3%-10.7%; P ≤ 0.001). Subgroup analysis suggests that children under age 4 are at a higher risk of complications in the perioperative period with an odds ratio of 1.64 (95% CI, 1.16-2.31).
Conclusion
The level of evidence supporting the safety of outpatient pediatric tonsillectomy is fair. The analyzed data show a higher rate of early complications and unplanned admissions in children under age 4.
Significance
The current evidence supports the practice of outpatient tonsillectomy in properly selected children.
EBM rating: A-1a
aDepartment of Otolaryngology–Head and Neck Surgery, National Naval Medical Center, Bethesda, MD
bDepartment of Pediatric Otolaryngology, Walter Reed Army Medical Center, Washington, DC.
Reprint requests: Matthew T. Brigger, MD, LCDR(Sel), MC, USNR, National Naval Medical Center, Department of Otolaryngology–Head and Neck Surgery, 8901 Wisconsin Avenue, Bethesda, MD 20889.
The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of the Army, the Department of Defense, nor the U.S. Government.
ABSTRACT