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Dr Fields' letter addresses an issue of pressing concern, namely, how to offer medical treatment that is both safe and cost-effective. The author's experience in performing outpatient tonsillectomy and adenoidectomy is impressive. However, as with any procedure, success rates will vary with patient mix, experience, and selection. The point that Drs Carithers and Gebhart were making in the report is not that all surgeons who perform tonsil and adenoid surgery on an outpatient basis necessarily are endangering the patient. Rather, they are suggesting that third-party payers should make a careful and thorough analysis of the risks and benefits of outpatient surgery, based on the experience of clinicians in a variety of settings. They believe that their data and the analytic model underlying it are a means of doing so, and will give the surgeon data on which to base his or her own clinical judgment.
Raymond CA. Outpatient Tonsil and Adenoid Surgery-Reply. JAMA. 1986;256(18):2519. doi:10.1001/jama.1986.03380180080019