Safety and outcomes of outpatient pediatric otolaryngology procedures at an ambulatory surgery center

Objectives: To determine the safety and outcomes of outpatient pediatric otolaryngology procedures performed at an ambulatory surgery center (ASC). Methods: Retrospective review of all pediatric otolaryngology cases performed at a freestanding, outpatient ASC of a tertiary care, academic children's medical center from 2000 to 2007. Results: Of all cases, 4979 (55%) were otolaryngology procedures. Twelve surgeons and 10 pediatric anesthesiologists staffed the cases; no residents/fellows were involved. The case breakdown is as follows: 2045 (41.1%) myringotomy and tympanostomy tube; 1438 (28.9%) adenoidectomy (with tympanostomy tube placement and/or turbinectomy); 880 (17.7%) tonsillectomy (with or without adenoidectomy). According to American Society of Anesthesiologist (ASA) classification: 84.2% were ASA I, 15.1% ASA II, 0.7% ASA III. There were nine unanticipated outcomes: four postadenotonsillectomy and one postadenoidectomy bleeds (three requiring reoperation the same day), two patients with low psuedocholinesterase levels, one postadenotonsillectomy patient requiring overnight monitoring, and one patient with an incidental finding of a subglottic mass. Preoperative ASA status on these nine patients was 7 (78%) ASA I, 2 (22%) ASA II. Conclusions: Pediatric otolaryngology procedures constitute significant volume at our ASC. Surgery at our ASC is extremely safe with a rate of unanticipated outcomes of 0.2%—a comparison not available in the literature. Pediatric otolaryngology procedures performed with a highly skilled team at an outpatient ASC result in high quality and safe surgery.