Overnight Monitoring After T&A for Children Ages 24-36 Months: Is It Always Necessary?

Abstract

To determine whether children < 3 years of age who do not require oxygen beyond 3 h and pass an asleep room air challenge (AsRAC), defined as maintaining a SpO₂ of ≥ 90% for 20 min during sleep, would be safe for discharge after tonsillectomy with or without adenoidectomy (T+/-A). All children aged 24-36 months undergoing T+/-A from 2019 to 2021 were included. Demographic, clinical, and polysomnography (PSG) results were stratified based on the presence of a prolonged oxygen requirement (POR) and compared using the Kruskal-Wallis test for continuous variables and Chi-squared test or Fisher's Exact tests for categorical variables. Univariate and multiple logistic models were performed. A total of 645 children were included. Overall, 524 (81.2%) successfully weaned from oxygen within 3 h of surgery, and 517 (98.7%) of patients who were off oxygen within 3 h never went back on oxygen during the monitoring period. Patient sex (OR = 1.88 [95% CI, 1.19-2.96]; p = 0.006) and diagnosis of chronic lung disease (CLD) (OR = 13.41 [95% CI, 3.69-48.81]; p < 0.0001) were the only statistically significant risk factors associated with a POR. No association was found between any of the preoperative PSG variables and a POR. Children between the ages of 24- and 36-months undergoing T+/-A who have weaned off oxygen within 3 h after surgery and passed an AsRAC would be candidates for same-day surgery. CLD was the only clinically relevant risk factor for a POR, and no preoperative PSG variables predicted POR.