Time-Based Triage After Pediatric Tonsillectomy: A Retrospective Analysis of 11,897 Patients

Saturday, October 11, 2025

10:12 AM - 10:18 AM EDT

Location: 233-234

Disclosure(s):

Alyssa C. Chapel, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: To characterize temporal patterns of post-tonsillectomy complications and evaluate the effectiveness of telephone triage based on time-dependent risk profiles.

Methods: This retrospective cohort study was conducted at a tertiary care children’s hospital and included 11,897 pediatric patients (aged 0–18 years) who underwent tonsillectomy between January 2020 and December 2024. Data from electronic medical records documented demographics, operative details, and postoperative events. Outcomes included the timing and type of telephone calls, emergency department (ED) visits, and bleeding events within 30 postoperative days. Intervention rates were compared between presentation pathways (telephone triage vs direct ED visits). Complication patterns were analyzed in three phases: early (days 2–4), mid (days 4–7), and late (>day 7).

Results: Of 11,897 patients, 2,630 (22.1%) made telephone calls, and 1,448 (12.2%) visited the ED. Early complications included dehydration (7.9%) and medication issues (8.5%). Mid-phase complications were dominated by bleeding (11.5%) and pain (52.0%), while late complications were varied (11.6%). Telephone triage managed 52.0% of pain-related calls, with only 27.4% requiring ED referral. For bleeding, the call-first pathway reduced interventions compared to direct ED visits (12.48% vs 16.37%; difference, 3.89% [95% CI, 2.14%-5.64%]; P<.001).

Conclusions: Post-tonsillectomy complications follow predictable temporal patterns that support phase-specific triage. Telephone triage effectively managed pain and bleeding, reducing unnecessary ED utilization and enhancing postoperative care.

Presenting Author(s)

Alyssa C. Chapel, MD

Resident
University of Texas Southwestern Medical School
Dallas, TX, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Senior Author(s)

Cynthia S. Wang, MD

Assistant Professor
UT Southwestern Medical Center
Dallas, TX, United States

Disclosure information not submitted.

Co-Author(s)

NK

Neila Kline, MD

Disclosure information not submitted.
SL

Saudamini Lele, MD

LSU Health - Shreveport, United States

Disclosure information not submitted.
RJ

Romaine F. Johnson, MD, MPH

Professor
Univ of Texas Southwestern Med Ctr
Dallas, Texas, United States

Disclosure information not submitted.
FL

Felicity MB Lenes-Voit, MD

Assistant Professor of Pediatric Otolaryngology
UT Southwestern
Dallas, TX, United States

Disclosure information not submitted.