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

ABSTRACT Objectives 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 SpO 2 of ≥ 90% for 20 min during sleep, would be safe for discharge after tonsillectomy with or without adenoidectomy (T+/−A). Methods 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. Results 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. Conclusions 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. Level of Evidence 4.