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Ambulatory tympanomastoid surgery in children: factors affecting hospital admission
Rashed A Hasan1, Michael J LaRouere, Jack Kartush
1Department of Pediatrics, Michigan State University, East Lansing, MI, USA. rashedh48@hotmail.com
Insights
Children undergoing tympanomastoid surgery with cholesteatoma, high pain scores, or requiring IV morphine sulfate face increased risks of postoperative nausea and vomiting (PONV) and delayed discharge. These factors are critical for managing pediatric surgical recovery.
Area of Science:
- Pediatric Otolaryngology
- Surgical Outcomes Research
- Anesthesiology
Background:
- Tympanomastoid surgery is a common otologic procedure in children.
- Postoperative nausea and vomiting (PONV) and failure to discharge on the same day are significant concerns impacting patient experience and healthcare resource utilization.
Purpose of the Study:
- To identify clinical predictors of PONV.
- To determine factors associated with failure to discharge children on the day of tympanomastoid surgery.
Main Methods:
- Retrospective review of 152 tympanomastoid procedures in 144 children.
- Data analysis focused on clinical factors, pain scores, and medication requirements.
Main Results:
- Mastoid procedures were associated with higher IV morphine sulfate use and lower PACU discharge rates compared to middle ear procedures.
- Cholesteatoma presence increased PONV risk in mastoid surgery patients.
- Pain scores ≥5, PONV, and IV morphine sulfate requirement predicted failure to discharge on the day of surgery.
Conclusions:
- Clinical factors such as cholesteatoma, elevated pain scores, and opioid requirements are associated with increased PONV and delayed discharge after pediatric tympanomastoid surgery.
- These findings aid in optimizing perioperative care and discharge planning for pediatric surgical patients.
Objective:
To identify clinical factors associated with postoperative nausea and vomiting (PONV) and failure to discharge from the hospital on the day of surgery in children undergoing tympanomastoid surgery.
Design:
Records of 144 children undergoing 152 tympanomastoid surgical procedures from July 1, 2001, through June 30, 2002, were retrospectively reviewed and the data analyzed.
Setting:
A tertiary care university-affiliated hospital.
Results:
The mean +/- SD age of the cases was 11 +/- 3.7 years. Sixty-eight cases (45%) were middle ear procedures, while 84 cases (55%) were mastoid procedures. Forty-three cases (28%) were discharged home from the postanesthesia care unit (PACU), 55 cases (36%) were discharged on the day of surgery, and 142 cases (92%) were discharged home from the day surgery unit (DSU) within 23 hours after surgery. Patients who underwent mastoid procedures were more likely to require intravenous (IV) morphine sulfate in the PACU (75% vs 56%; P = .02) and were less likely to be discharged from PACU (15% vs 44%; P<.001) compared with patients who had middle ear procedures. In patients who underwent mastoid procedures, the presence of cholesteatoma (odds ratio, 1.9; 95% confidence interval, 1.0-3.7; P = .04) was associated with a higher likelihood of PONV. In both groups, the need for IV morphine sulfate to control pain on admission to DSU was associated with a higher occurrence of PONV. Factors that were significantly associated with failure to discharge from the hospital on the day of surgery were a pain score of 5 or greater, the presence of PONV, and the requirement of IV morphine sulfate on admission to DSU.
Conclusions:
Factors associated with higher risks of PONV and failure to discharge from the hospital on the day of surgery include the presence of cholesteatoma, a pain score of 5 or greater, and the requirement of IV morphine sulfate at the time admission to the DSU.
