Factors Predictive of Adverse Postoperative Outcomes in Children Undergoing Tonsillectomy

• Immediate postoperative adverse event [ Time Frame: Post-anesthetic recovery room (PACU), an expected average of 2 hours ] [ Designated as safety issue: Yes ]
  This will be measured in post anesthesia care unit (PACU) and will be a composite measure of any one or a combination of these: desaturation, somnolence, laryngospasm /airway obstruction, airway instrumentation, drug administration, PACU discharge criteria not met, unanticipated hospital or ICU admission.
  
  

• Late Postoperative Adverse Event [ Time Frame: Assessed at 24 h and 3 weeks post discharge ] [ Designated as safety issue: No ]
  Assessed by electronic chart review and telephonic call to the families. The variables of interest are: Unanticipated hospital readmission, ICU admission, ER visit.
  
  

Currently, children are scheduled to go home or stay in the hospital depending on expert consensus and institutional guidelines. The investigators preliminary experience (Dr. Sadhasivam PI: IRB No. 2008-0848) with the pharmocogenetic study, studying the phenotypic and genotypic influences of pain and use of opioids in patients undergoing tonsillectomy indicates that a significant number of patients scheduled as outpatients experience prolonged recovery phases in the PACU, some of whom are admitted or re-admitted following discharge. The identification of those factors that are, predictive of adverse events in tonsillectomy patients and the development of a prototype prediction model in this single-center study to support clinical decision-making. The rationale of this project is that developing a model to predict postoperative adverse events will not only lead to improved clinical outcomes and enhance patient safety, but also reduce family psychosocial distress associated with unanticipated hospital visits or re-admission, while reducing the burden on the health care system.