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Endaural Endoscopic Atticoantrotomy (Retrograde Mastoidectomy) using a Constant Suction Bone-drilling Technique
Published on: May 23, 2021
Day-case paediatric mastoid surgery
Richard Gareth Rowlands1, Robert Harris, Jonathan David Hern
1Department of Otolaryngology, Mayday University Hospital and St George's Hospital, London, UK. growlands1@aol.com
Insights
Many children can safely undergo mastoid surgery as day cases, improving efficiency. The type of mastoid procedure performed significantly influences whether a child requires an overnight hospital stay.
Area of Science:
- Pediatric Otolaryngology
- Surgical Day Care
Background:
- Traditionally, children require overnight hospitalization after mastoid surgery.
- Adult studies suggest same-day discharge is feasible for many patients.
Purpose of the Study:
- To determine the proportion of pediatric patients suitable for same-day discharge after mastoid surgery.
- To identify factors influencing the decision for same-day discharge versus inpatient admission.
Main Methods:
- Retrospective data collection on 35 children undergoing mastoid operations (February 1994 - December 2000).
- Standardized proforma recorded operative findings, anesthesia duration, and patient disposition.
- Preoperative bed booking with intent for discharge if feasible.
Main Results:
- Suitability for same-day discharge increased from 20% pre-1998 to 75% (9/12) between 1998-2000.
- A significant relationship was found between the extent of mastoid surgery and inpatient admission.
- Day-case mastoid surgery demonstrated comparable complication and success rates to inpatient procedures.
Conclusions:
- Pediatric mastoid procedures can be safely performed on a day-case basis.
- The specific mastoid procedure is the primary factor determining inpatient admission necessity.
- Advancements in surgical techniques may expand the scope of day-case mastoid procedures for children.
Objective:
Children have traditionally been kept in hospital overnight after mastoid surgery, but evidence from the US in adults suggests that a substantial number of patients may be suitable for discharge on the day of surgery. We sought to ascertain the proportion of our children having mastoid operations between February 1994 and December 2000 who were suitable for same-day discharge. We also evaluated some of the factors that prevented discharge the same day.
Methods:
A standard proforma was used to record relevant data in 35 children (mean age 10 years 6 months) undergoing consecutive mastoid operations at Mayday University Hospital, London, UK. Operative findings, duration of anaesthesia and time back on ward were recorded as well as details regarding admission, follow-up findings and complications. A bed was booked preoperatively but there was intent to discharge the patient if feasible.
Results:
Nine out of twelve patients (75%) operated between 1998 and 2000 were suitable for discharge on the day of surgery. The pre-1998 discharge rate was 20%. Only one of the former group of patients underwent a modified radical mastoidectomy in comparison with ten such procedures pre-1998. There was a significant relationship between extent of surgery and in-patient admission. The outcomes of day-case mastoid surgery, in terms of complications rates and overall success rates, were comparable with surgery performed on an in-patient basis. Using correlation analysis, no relationship could be found between duration of anaesthesia and time of arrival back on the ward and in-patient admission.
Conclusion:
Children can undergo mastoid procedures safely and effectively on a day-case basis but should still have a bed booked pre-operatively as the majority will require admission. The main factor related to admission was the mastoid procedure performed. With improvements in surgical and anaesthetic techniques and other advances, operations such as atticotomy may become standard day-case procedures in paediatric patients.
