Pediatric Adenoidectomy With Laryngeal Mask Airway in the Minor Procedure Room: A Quality Improvement Project

Importance Expanding the appropriate use of ambulatory surgical care may improve operating room (OR) efficiency. Objective To demonstrate that pediatric adenoidectomy with laryngeal mask airway (LMA) for select patients in the minor procedure room (MPR) is comparable in safety but more efficient than OR adenoidectomy in a pilot study of 20 patients from July to November 2023. Design The Institute for Healthcare Improvement Model for Improvement guided this quality improvement project. Safety and efficiency outcomes were prospectively collected for adenoidectomies with LMA in the MPR and compared with retrospective data from similar OR cases with LMA or endotracheal intubation (ETT). Setting A single tertiary referral center. Participants Pediatric patients who underwent adenoidectomy from July to November 2023. Interventions The intervention involved adenoidectomy in the MPR with LMA, as opposed to traditional OR settings. Main Outcome Measures The main outcome measures included safety (perioperative respiratory adverse events, conversion from LMA to ETT), efficiency (length of hospital stay, wait time for surgery), and patient/provider satisfaction. Results Final analysis included 55 patients [20 (36%) MPR, 35 (64%) OR]. In the OR, 16 (46%) patients used LMA, the rest used ETT. The median [interquartile range (IQR)] age was 5.5 (3.7-7.3) years, and 22 (41%) patients were female. No major respiratory adverse events occurred in the MPR compared to 1 (3%) event in the OR. One (5%) MPR patient required conversion from LMA to ETT due to limited surgical access. Time-based measures were superior in the MPR, with median hospital stay 91 minutes shorter (158.0; IQR: 143.0-204.0 vs 249.0; IQR: 210.0-278.0). Patient and provider satisfaction were highly rated in the MPR. Conclusions Pediatric adenoidectomy for select patients in the MPR is a safe and time-efficient alternative to the OR. Relevance Further exploration of suitable procedures for the MPR may enhance OR resource allocation. Level of Evidence. 3