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Social conditions and paediatric day case tonsillectomy
1Department of ENT, Birmingham Children's Hospital NHS Trust.
Insights
A new formula helps assess suitability for day case tonsillectomy in children. Social factors significantly impact suitability, with less deprived children being more likely candidates for day surgery.
Area of Science:
- Pediatric Surgery
- Health Services Research
- Social Determinants of Health
Background:
- Assessing suitability for day case tonsillectomy is crucial for efficient healthcare resource allocation.
- Previous methods lacked a standardized approach considering both medical and social factors.
- Disparities in day case surgery rates may exist due to socioeconomic variations.
Purpose of the Study:
- To develop a straightforward method for evaluating the proportion of children suitable for day case tonsillectomy.
- To identify key medical and social characteristics influencing day case suitability.
- To create a tool for setting realistic day case targets based on patient demographics.
Main Methods:
- Selected four suitability criteria: medical contraindications (ASA grade 2+), home circumstances (telephone, car, single parent), distance (>10 miles), and complication likelihood.
- Collected prospective data from 500 children under 12, including Jarman UPA8 deprivation scores.
- Utilized logistic regression to analyze the relationship between deprivation and social suitability for day case tonsillectomy.
Main Results:
- Social suitability for day surgery decreased with increasing deprivation, from 95% in the least deprived to 55% in the most deprived quintile.
- Developed a formula for day case tonsillectomy targets: A x B x C x D x 100%, incorporating medical, social, distance, and complication factors.
- Highlighted the impact of socioeconomic status on the feasibility of day case procedures.
Conclusions:
- The developed formula enables purchasers and managers to set differential day case targets for tonsillectomy.
- The approach can be adapted for other surgical procedures and age groups.
- This method promotes equitable access to day case surgery by accounting for patient characteristics.
Objective:
To develop a simple method for assessing the proportion of children referred to hospital for tonsillectomy in different areas likely to be suitable for day case treatment based on their medical and social characteristics.
Methods:
Four patient suitability criteria were selected based on previous experience of successful day case surgery and a literature review of the prevalence of contraindications and postoperative complications, as follows: medical contraindications (at least American Society of Anesthetists grade ASA2 to be eligible); home circumstances (no telephone, no car and single parent households were ineligible); distance from the hospital (more than 10 miles resulted in ineligibility); and likelihood of postoperative complications. Data relating to the social criteria were collected prospectively from 500 children under 12 years of age reviewed in the outpatient department and under the care of one of the authors. In addition, the electoral ward UPA8 (Jarman 8) deprivation score relevant to each child was recorded and the sample was divided into quintiles according to mean UPA8 scores. In each quintile, the percentage of children with the appropriate social criteria for day case tonsillectomy was calculated. The relationship between deprivation score and social criteria for day case tonsillectomy was determined using logistic regression.
Results:
The proportion of children deemed socially suitable for day surgery fell continuously from 95% in the least deprived quintile to 55% in the most deprived group (proportion passing the social criteria for suitability = -1.5035 + 0.0298UPA8). Using these findings and those from the literature review on the nature and prevalence of contraindications and postoperative complications, a simple formula for realistic day case tonsillectomy targets was specified as A x B x C x D x 100%, where A is the proportion of children with no additional medical problems, B is the proportion passing the social suitability criteria, C is the proportion living within 10 miles and D is the proportion with no postoperative complications. Values for A and D would be derived from local audits.
Conclusions:
The formula can be used by purchasers and hospital managers to set differential day case targets for hospitals related to the characteristics of their patients referred for tonsillectomy. In principle, a similar approach could be applicable to other procedures and other age groups.