Inpatient and Outpatient Specialty Care Clinical Pathway to Triage Tonsillectomy and/or Adenotonsillectomy Patients with or without Preoperative Polysomnography

Goals and Metrics
Patient Education
Provider Resources
Tonsillectomy and Adenotonsillectomy Patient
with or without Pre-Operative Polysomnography
Consider Sleep Study for Patients at Risk for Complications Intra/Postoperatively
  • Down syndrome
  • Craniofacial anomalies
  • Neuromuscular disease (incl. cerebral palsy)
  • Chronic lung disease
  • Sickle cell disease
  • Metabolic disease
  • BMI ≥ 95th percentile
ENT Office Visit
Ambulatory Surgery Center
CHOP Day Surgery
CHOP Inpatient
Post-surgery/Perianesthesia Care Unit
If patient does not meet discharge criteria, admit to PICU or inpatient surgical unit

Discharge Criteria

Discharge Instructions

Surgery/Perianesthesia Care Unit

Determine Disposition
PICU
Inpatient Surgical Unit

Discharge Criteria (SPIT)

Minimum Fluid Intake

Discharge Instructions

Criteria to Determine Surgery Location and Postoperative Management
  Ambulatory Surgical Center (ASC) CHOP Day Surgery CHOP Inpatient
Age ≥ 3 1/2 y/o
Comorbid conditions cleared
by Anesthesia		 > 3 y/o
No comorbid conditions		 All patients < 3 y/o OR > 3 y/o with comorbid conditions
Weight ASC Patient Selection Policy
ASC Patient Selection Guidelines Job Aid		 ASC Patient Selection Policy
ASC Patient Selection Guidelines Job Aid		 BMI ≥ 35
Polysomnography Results (if applicable) AHI 0-23 and
No high-risk gas exchange concerns
Peak CO2 ≤ 55, O2 nadir ≥ 90
85-89% with approval from ASC
medical director		 AHI 0-23 and
No high-risk gas exchange concerns
Peak CO2 ≤ 60, O2 nadir ≥ 85		 AHI > 23 and
High-risk gas exchange concerns
Peak CO2 ≥ 60, O2 nadir ≤ 85
Bed Request None None PICU or Inpatient Surgical Unit
Posted: July 2016
Revised: July 2022
Authors: L. Elden, MD; T. Giordano, DNP; D. Davis, MD; B. Struyk, MD; E. Phillips, RN; D. Toner, CRNP; C. Petro, BSN; A. Williams, CRNP