Safety of Same-day Discharge After Tonsillectomy for Children in the Class 1 Obesity Category

Introduction: Our objective was to determine if there are increased adverse respiratory events (ARE) in children in the class 1 obesity category following tonsillectomy in order to see whether these class of patients are safe for same-day discharge.

Methods: All patients 3 to 18 years old that underwent tonsillectomy June 1, 2022, to May 31, 2024, were included. Patients with comorbidities that warranted admission such as polysomnogram (PSG)-confirmed severe sleep apnea, Trisomy 21, neuromuscular disorders, and congenital heart disease were excluded. Patients were categorized into four classes based on BMI: Class 0 (BMI < 95th percentile), Class I (BMI ≥ 95th percentile to < 120% of the 95th percentile), Class II (BMI ≥ 120% to < 140% of the 95th percentile), and Class III (BMI ≥ 140% of the 95th percentile). Time to discontinuation of supplemental oxygen and AREs following tonsillectomy were recorded. AREs included new oxygen requirements, desaturations (Sp02 < 90%), or need for continuous positive airway pressure.

Results: There was no significant difference in durations of postoperative supplemental (PSO) oxygen in Class I or II patients compared to Class 0. Patients in Class III required longer durations of PSO compared to Class 0 (p < 0.002). There were no increased AREs in Class I or II compared to Class 0 in the postoperative care unit or during inpatient stay; however, there were increased AREs in patients in Class III (p < 0.003). Among the 106 patients in Class I who underwent same-day discharge, no patients required readmission for respiratory complications.

Conclusions: Patients with Class I and Class II obesity were not associated with increased AREs following tonsillectomy compared to non-obese patients. Additionally, preliminary findings of same-day discharge in patients with Class I obesity following tonsillectomy did not result in increased readmission for respiratory distress, indicating that this subset of obese patients may not necessitate overnight observation for postoperative respiratory monitoring.