Day-case adenoidectomy: outcomes are improved using suction coagulation and prophylactic anti-emetic treatment

In 2004, the Department of Health published 10 High Impact Changes across the NHS. Of these, the first was treating day surgery as the norm for elective operations, releasing up to half a million in-patient beds each year. Adenoidectomy is an operation commonly performed in children for upper respiratory tract obstruction and as part of the surgical management of otitis media with effusion. Many surgeons consider the traditional curettage adenoidectomy as an unsatisfactory operation because it is performed blind, and is associated with varying reported levels of post-operative bleeding. Concern about the risk of bleeding and the frequent occurrence of post-operative nausea and vomiting have discouraged many surgeons from adopting adenoidectomy as a day-case procedure. We have audited the management and discharge of a cohort of 72 children undergoing traditional curettage adenoidectomy. Based on the results, we have completed the audit loop, by managing a second cohort of 77 children by suction coagulation adenoidectomy. An anaesthetic protocol has been designed to reduce post-operative nausea and vomiting, and facilitate same day discharge from hospital. The rate of post-operative nausea and vomiting fell from 21 to 1.3%, and the post-operative bleeding from 9.7% to nil. Discharge on the day of operation rose from 40.3 to 100%. Our audit confirms that these measures permit safe, day-case adenoidectomy.