Revisit Rates for Pediatric Tonsillectomy: An Analysis of Admit and Discharge Times

Abstract

Objective: To determine the association between intraday timing of outpatient pediatric tonsillectomy and revisit outcomes and complications. Study Design: Cross-sectional analysis of New York databases. Setting: Ambulatory surgery, emergency department and inpatient hospital settings. Subjects and Methods: The State Ambulatory Surgery, State Emergency Department and State Inpatient Databases for 2010-2011 were analyzed for revisits. Outcomes assessed were revisits for any reason, bleeding, acute pain or fever, nausea, vomiting and dehydration. The relationships between the hour of admission for surgery, the hour of discharge and the revisit outcomes were analyzed. Results: The study included 33,611 children (mean age, 6.62 years; 45.7% female) and 62.0% were admitted in the early morning. Discharges were most common in the early afternoon (28.3%). Revisit rates were significantly higher for the early evening discharges (6.0%) versus late morning discharges (3.1%) ( P < .001). Revisits for bleeding were 1.8% for discharge in the early evening versus 0.6% in the late morning ( P < .001). Revisits for fever, nausea, vomiting or dehydration were 1.8% for discharge in the early evening versus 0.9% in the late morning ( P = .002). Late afternoon admission was significantly associated with higher revisit rates (10.9%, P < .001). Bleeding revisits were highest for late afternoon admit hour (1.5%, P = .001). Revisits for acute pain were also highest for late afternoon admit hour (2.3%, P = .005). Conclusion: Revisit are significantly higher when the patient is discharged late. Late afternoon surgery is also significantly associated with higher revisit rates. Surgeons may wish to consider these findings when a late tonsillectomy or late discharge is anticipated post-tonsillectomy.