Contemporary recovery following pediatric powered intracapsular tonsillectomy: a 12-year cohort study

Current pediatric tonsillectomy guidelines provide postoperative monitoring and analgesic recommendations largely derived from extracapsular tonsillectomy populations, without addressing intracapsular techniques. Given the distinct postoperative profile of intracapsular tonsillectomy, we evaluated temporal trends in recovery duration following powered intracapsular tonsillectomy (PIT) and adenoidectomy (PITA), including among children younger than 3 years, and characterized concurrent changes in postoperative analgesic practices. In this single-center retrospective cohort study, children ≤ 18 years undergoing PIT/PITA between 2013 and 2024 were identified from electronic health records. Patients undergoing extracapsular tonsillectomy, coblation intracapsular tonsillectomy, adenoidectomy alone, emergent procedures, or those with missing analytic variables were excluded. Multivariable regression analyses were used to evaluate temporal trends and factors associated with PACU LOS and postoperative analgesic administration. Among 3,463 children (mean age, 4.8 years; 27.2% aged < 3 years), recovery duration shortened substantially over the study period, reaching a median PACU LOS of 63 min in ambulatory settings and 92 min in hospital settings by 2024. In adjusted analyses, later year of surgery was associated with shorter PACU LOS relative to 2013, with a 45.7-min reduction in recovery duration (95% CI, -73.5 to -17.8) in 2024. Similar improvements were observed among children younger than 3 years, for whom the adjusted reduction in PACU LOS reached 62.5 min in 2024 (95% CI, -103.1 to -21.8). Concurrent postoperative analgesic practice shifted away from opioid administration and, following the introduction of ketorolac in 2020, from ibuprofen toward ketorolac (0.4% to 44.2%). Perioperative anesthesia complications (2.2%) and unplanned admissions (0.3%) were rare. Contemporary recovery following pediatric intracapsular tonsillectomy may not be adequately represented by existing tonsillectomy postoperative expectations. These findings support prospective evaluation and development of intracapsular tonsillectomy-specific perioperative pathways and monitoring recommendations.