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

## TL;DR

The study finds that most young children who pass a breathing test after tonsil and adenoid surgery can go home the same day, unless they have chronic lung disease.

## Contribution

Identifies male gender and chronic lung disease as the only significant risk factors for needing overnight oxygen after T+/−A in young children.

## Key findings

- 98.7% of children who stopped needing oxygen within 3 hours after surgery did not require it again.
- Male sex and chronic lung disease were the only significant predictors of prolonged oxygen requirement.
- Children passing an asleep room air challenge can be considered for same-day discharge after T+/−A.

## 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.

4.

This study aims to identify whether all children < 3 years of age require overnight admission after tonsillectomy with or without adenoidectomy. We found that 98.7% of children who were off oxygen within 3 h after surgery never went back on oxygen during the entire monitoring period. Male gender and chronic lung disease were the only statistically significant risk factors for a prolonged oxygen requirement. In conclusion, 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 asleep room air challenge would be candidates for same‐day surgery.