Elyse Gutierrez, BS, MD, Microbiology
Attending Physician
Children's Hospital LA
Los Angeles, California
Disclosure information not submitted.
Vanessa Toomey, MD, MBA
Childrens Hopital Los Angeles
Los Angeles
Disclosure information not submitted.
Patrick Ross, MD
Pediatric Critical Care Medicine and Anesthesia Associate Professor
Children's Hospital Los Angeles and Keck School of Medicine of USC, United States
Disclosure information not submitted.
Fernando Beltramo, MD
Assistant Professor of Pediatrics
Children's Hospital Los Angeles, United States
Disclosure information not submitted.
Anoopindar Bhalla, MD
Associate Professor of Clinical Pediatrics
Children's Hospital Los Angeles, USC
Los Angeles, California
Disclosure information not submitted.
Title: ICU Admission in Children After Tonsillectomy
INTRODUCTION/HYPOTHESIS: Currently, there are no consensus guidelines to identify high risk pediatric patients requiring intensive care unit (ICU) admission after tonsillectomy. We sought to characterize ICU admissions after tonsillectomy and determine if hospital level characteristics are associated with longer length of stay, increased need for mechanical ventilation, and higher incurred costs.
Methods: We completed a retrospective review using the Pediatric Health Information System (PHIS) database, to identify pediatric patients ≤ 18 years old admitted after tonsillectomy between 2010 to2020. Exclusions included children with a complex chronic condition and patients transferred from other institutions.
Results: A total of 85,267 children from 49 hospitals were included in the analysis with 4,341 (5.1%) admitted to the ICU. Most children were admitted for 1 day (n=75,882, 89%) with a longer median length of stay in children admitted to the ICU (1 day (IQR 1,2)) compared to those admitted to the floor (1 day (IQR 1, 1))(p=0.0001). Of children admitted to the ICU, 257 (5.9%) required either non-invasive or invasive ventilation with an associated ICU length of stay > 2 days. Non-white children, males, older children, and those with non-commercial insurance were more likely to be admitted to the ICU (all p< 0.01) in multivariable analysis. The percentage of children admitted to the ICU varied by hospital and year (median 2.11% per year (IQR 0.92%, 6.19%)) as did the number of admissions (median 555 admissions per year (IQR 281, 758). A higher percentage of ICU admissions and a lower number of hospitalizations per year for the hospital were both independently associated with higher adjusted total costs, higher use of non-invasive or invasive ventilation, and increased length of stays > 2 days after controlling for confounding variables and center level effects (all p< 0.01).
Conclusions: The majority of children admitted to the ICU after tonsillectomy are admitted briefly and do not require mechanical ventilation respiratory support. Variability in admission practices and hospital volume may impact length of stay, cost, and use of mechanical ventilation.