(A910) Assessment of Need for Oxygen Support During Extended Recoveries for Pediatric Intracapsular Tonsillectomy and Adenoidectomy

Introduction: Tonsillectomy & adenoidectomy are one of the most common otolaryngology procedures performed in the United States. While most of these procedures are done on outpatient basis, existing guidelines recommend observing certain patients overnight. These patients include children under 3, medically complex children, children with severe obstructive sleep apnea, and children with morbid obesity. Data to support which patients benefit from observation is limited.

Methods: This study is a retrospective review of patients at the single pediatric tertiary care hospital from January 1, 2022 to December 4, 2024 who stayed overnight in the hospital following tonsillectomy and adenoidectomy surgery. Charts for analyzed to identify which patients required oxygen supplementation overnight in which patient's did not require intervention. Charts were also reviewed for demographic factors, BMI, medical comorbidities, and sleep study scores.

Results: Overall, 742 patients were kept overnight for observation based on current guidelines. 30 (4%) required oxygen supplementation for anywhere from 30 minutes to 15 hours postoperatively. Of these, 8 had been kept for age, 9 had been kept for BMI, and 9 had been kept for severe sleep apnea on sleep study. The remaining 4 were kept for a combination of those factors. There were no historical or physical exam findings that seem to predict need for supplemental oxygen during overnight monitoring.

Conclusions: Only a very small percentage of patients kept overnight for monitoring after tonsillectomy and adenoidectomy require intervention with oxygen postoperatively. Changes in practice patterns, such as reduced use of narcotics intraoperatively and postoperatively, may have changed the landscape of pediatric tonsillectomy recovery. Guidelines on which patients will benefit from overnight observation require greater clinical evidence to limit the number of patients who are kept unnecessarily.