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Background: Severe obstructive sleep apnoea (OSA) is associated with increased risk of respiratory compromise in the post‐operative period following adenotonsillectomy (AT). This study analyses the economic cost of polysomnography or overnight oximetry as part of pre‐operative risk stratification in paediatric AT, supplementing previously published research demonstrating the efficacy of this protocol in predicting respiratory complications. Methods: This cost‐minimisation analysis examines costs associated with pre‐operative overnight oximetry and polysomnography in triaging paediatric patients older than 2 years old, with no major comorbidities except for OSA, undergoing AT for OSA (n = 1801) to either a secondary or quaternary Australian hospital. Decision analysis modelling via probability trees were utilized to estimate pre‐ and peri‐operative costs. A third hypothetical 'no investigation' model based upon conducting all AT at a secondary hospital was performed. Costs are derived from the financial year 2020–2021, censored at discharge. Results: The total cost per patient of AT including pre‐operative investigations of oximetry and polysomnography, and associated inpatient costs, were AUD4181.34 and 5013.99 respectively. This is more expensive compared to a hypothetical no‐investigation model (AUD3958.98). Conclusion: Within the scope of this partial economic evaluation, this study finds a small additional cost for a model of care involving overnight oximetry as a pre‐operative triage tool, balanced by the reduced cost of care in a lower acuity centre for low‐risk patients and potential high cost of complications if all children are treated in a low acuity centre. This supports oximetry in peri‐operative risk stratification for paediatric AT from a financial perspective. [ABSTRACT FROM AUTHOR]

Background: Swan Hill District Health (SHDH) provides Otolaryngological services to outer regional Victoria. A preoperative checklist determines eligibility for tonsillectomy, and the role of preoperative investigations such as oximetry. Visiting specialists who provide T&A also remain on‐site for 24 h post‐surgery. Management of post‐discharge complications is supported by SHDH's Emergency Department. Unstable patients are transferred to tertiary care hospitals. This study examines the safety outcomes associated with rural Tonsillectomy and adenotonsillectomy (T&A) and the impact of peri‐operative protocols on these outcomes. Methods: This is a retrospective cohort study of all paediatric (2–18 years old) patients undergoing T&A from August 2014 to June 2020 at SHDH. Four external hospital databases which accept patient transfers from SHDH were searched for T&A‐related complications. The primary outcome was complication incidence. Secondary outcomes were length of stay, and rates of hospital readmissions, return to theatre and inter‐hospital transfer. Results: Two hundred and four patients were included, with median age 6 years old; 68.1% (n = 139/204) had obstructive sleep apnoea, or sleep disordered breathing, wherein 36.0% (n = 50/139) had documented evidence of normal/inconclusive oximetry. The complication rate is 6.9% (n = 14/204), with two intraoperative, five perioperative and seven post‐discharge complications. All intra‐ and peri‐operative complications were managed locally. All post‐discharge complications presented to outer regional EDs. Two patients required inter‐hospital transfer for monitoring of post‐tonsillectomy bleeds in a specialist unit. Conclusions: Patients who pass a preoperative risk checklist can safely undergo T&A in selected rural settings which adhere to strict patient selection criteria and implement safety measures to address complications. [ABSTRACT FROM AUTHOR]