From the Guidelines
Patients can be safely discharged after tonsillectomy when they meet specific criteria, including being over 3 years old, not having severe OSA, and demonstrating adequate oral intake, pain control with oral medications, no significant bleeding, and normal vital signs, as recommended by the 2019 clinical practice guideline for tonsillectomy in children 1.
Discharge Criteria
To ensure safe discharge, the following criteria should be met:
- The patient should be over 3 years old or not have severe OSA (AHI ≥ 10 obstructive events/hour, oxygen saturation nadir <80%, or both) 1.
- The patient should demonstrate adequate oral intake, with the ability to drink clear liquids without vomiting.
- Pain control should be achieved with oral medications, such as ibuprofen, acetaminophen, or both, as recommended by the guideline 1.
- There should be no significant bleeding, and the patient's vital signs should be normal.
Pain Management
Pain management is essential for minimizing postoperative morbidity. The guideline recommends the use of ibuprofen, acetaminophen, or both for pain control after tonsillectomy 1.
- Ibuprofen and acetaminophen can be used in combination, with dosing adjusted according to the patient's weight and age.
- The use of codeine or any medication containing codeine is strongly recommended against due to the FDA black box warning against its use in children after tonsillectomy 1.
Post-Discharge Care
After discharge, patients should be instructed to:
- Maintain hydration with at least 2 liters of fluid daily.
- Follow a soft diet for 7-10 days.
- Monitor for warning signs requiring immediate medical attention, such as bright red bleeding, fever above 101.5°F, severe pain uncontrolled by prescribed medications, or inability to maintain hydration.
- Schedule a follow-up appointment for 1-2 weeks post-surgery.
From the Research
Discharge Criteria for Post-Tonsillectomy Patients
- The decision to discharge a patient after tonsillectomy depends on various factors, including postoperative pain management, risk of bleeding, and overall patient condition 2, 3, 4, 5, 6.
- Studies have shown that patients can be safely discharged with adequate pain management using medications such as ibuprofen and acetaminophen 3, 4, 5.
- The use of antibiotics is not routinely recommended for post-tonsillectomy patients, unless there is a specific indication such as infection 2.
- Patients should be instructed on how to manage postoperative pain, bleeding, and other potential complications before discharge 6.
Postoperative Pain Management
- Ibuprofen and acetaminophen are commonly used for postoperative pain management after tonsillectomy, with no significant difference in efficacy between the two 3, 4, 5.
- Alternating doses of ibuprofen and acetaminophen can provide effective pain relief for most patients 5.
- Narcotics may be prescribed for severe pain, but with caution in patients with obstructive sleep apnea 6.
Bleeding and Complications
- The risk of postoperative bleeding is a concern after tonsillectomy, but studies have shown that ibuprofen does not increase this risk 4, 5.
- Patients should be monitored for signs of bleeding and other complications, such as dehydration and nausea, before discharge 2, 3, 4, 5.
- Patients with severe bleeding may require surgical intervention 5.