Outpatient Tonsillectomy in Children: A Systematic Review

Abstract

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