Predictive factors for prolonged hospital stay in pediatric tonsillectomy patients

Objective: To determine factors that may potentially predict a prolonged hospital stay after scheduled tonsillectomy in the pediatric population. Study Design: Retrospective chart review. Subjects and Methods: A review of pediatric patients who had undergone a tonsillectomy at a tertiary medical center from July 2007 to November 2010 was made. Preoperative variables were analyzed to determine predictors of prolonged hospital stay (defined as >24 h) that may have influenced their length of stay. Setting: Tertiary care medical center. Results: 827 patient charts were reviewed. One hundred and one patients (12.2 %) had hospital stays >24 h. Indications for tonsillectomy included obstructive sleep apnea (69.2 %), tonsillitis (13.8 %), and tonsillar asymmetry (0.9 %). Seventy-seven (76.2 %) patients of the extended stay group had a delayed discharge because of poor oral intake. Fever and respiratory complications accounted for 0.5 and 1.8 % respectively of those patients who had extended stays. Patients with extended stays were younger (p < 0.001) and weighed less (p < 0.001). Patients with a history of sickle cell crises, reactive airway disease, bronchodilator use, and anti-reflux medication use (p < 0.05) were more likely to have a prolonged hospital stay. Conclusion: Factors from the history and physical of pediatric patients may predict which children are at higher risk for extended hospital stays after routine tonsillectomy. Predictors of extended stays include those under the age of four and children weighing <20 kg, those with a history of sickle cell crises or reactive airway disease, and those using bronchodilators or anti-reflux medication.