Outpatient Adenotonsillectomy Is Possible
It's time to reconsider guidelines calling for automatic overnight stays.
Jacqueline Jones, MD
Most of my pediatric adenotonsillectomy patients are complication-free following surgery and head home without issue. So can a procedure performed approximately 250,000 times each year in the United States be done safely in the outpatient setting? Yes, I've proven that. But it has to be done in the right types of facilities on the right types of patients, who are cared for by properly trained perioperative teams. The decision to discharge patients is based on a host of clinical and environmental factors unique to individual patients, but sending patients home on the day of surgery is something surgical facilities can and should start to consider.
This is the first installment of a year-long series that will make the case for performing more procedures in outpatient surgical facilities, where more efficient care leads to significant cost savings and improved patient satisfaction. Check back next month for a look at ventral hernias.
My patients (and their parents) are a select group. They live within an hour-and-a-half of New YorkPresbyterian Hospital, a tertiary care medical center in New York City where I operate, so they're not driving as far for care as they might in less-well-served areas. We exclude children who have medical conditions such as severe asthma, bleeding disorders, cranio-facial abnormalities and morbid obesity — anything that would place them in a high-risk population.
Presby is filled with incredible pediatric anesthesiologists and nurses who understand how to maintain safe, efficient care. Nurses spend more time with surgical patients than physicians do, so having seasoned RNs who work as a team is essential to performing these cases on an outpatient basis. The recovery room staff is highly trained in monitoring pediatric adenotonsillectomy patients, having undergone in-services with anesthesiologists and otolaryngologists. An anesthesiology resident works in the PACU and is available for nurses to consult if questions or concerns arise during recovery. Plus, I'm always around and available.
The kids undergo a great deal of observation by highly trained caregivers before being discharged. We assess underlying medical conditions that could raise red flags, and review surgeries to determine if they were routine or more difficult than expected. Patients have to tolerate a minimum of 6 to 8 ounces of fluid, depending on their age. Their oxygen saturation level needs to be above 95% for at least 2 to 3 hours after the administration of pain medication.