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Published on: November 6, 2019
Perioperative management of sickle cell disease children undergoing adenotonsillectomy
Rebecca L Duke1, J Paul Scott, Julie A Panepinto
1Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA. rduke@mcw.edu
Insights
Outpatient management for children with sickle cell disease (SCD) undergoing adenotonsillectomy shows similar complication rates to traditional inpatient care. This approach allows for shorter hospital stays, establishing a new standard for perioperative care.
Area of Science:
- Pediatric Surgery
- Hematology
- Anesthesiology
Background:
- Adenotonsillectomy is a common procedure in children with sickle cell disease (SCD).
- Traditional perioperative management involves extended hospital stays (3-5 days).
- Concerns exist regarding potential complications in SCD patients post-surgery.
Purpose of the Study:
- To evaluate the complication rate of tailored outpatient perioperative management for SCD children undergoing adenotonsillectomy.
- To compare these rates with previously published data for inpatient management.
Main Methods:
- Retrospective chart review of 41 SCD children who underwent tonsillectomy.
- Outcome measures included perioperative management details and postsurgical complications.
Main Results:
- 61% of patients were monitored for less than 24 hours, with an average length of stay of 2 days.
- Postoperative complications occurred in 22% of patients (hypoxia 20%, fever 10%, acute chest syndrome 8%, airway fire 2.4%).
- These complication rates are comparable to those reported in the literature for longer hospital stays.
Conclusions:
- Tailored outpatient perioperative management for SCD children undergoing adenotonsillectomy is feasible.
- Shorter hospitalization (<24 hours) can be achieved with similar complication rates.
- This study proposes a new paradigm for managing SCD patients undergoing this procedure.
Objective:
To determine if outpatient tailored perioperative management has the same complication rate as that previously published for sickle cell disease (SCD) children who undergo adenotonsillectomy.
Study Design And Setting:
Retrospective chart review of SCD children who underwent tonsillectomy with outcome measures of perioperative management and postsurgical complications.
Results:
Of 41 patients, 61% were monitored for <24 hours with the average length of stay being 2 days (range, 1 to 10). Postoperative complications were noted in 9 (22%) patients, including 8 (20%) with hypoxia, 4 (10%) fever, 3 (8%) acute chest syndrome, and 1 (2.4%) airway fire, which are similar to the published literature.
Conclusions:
Current literature supports extensive perioperative management with hospital stays averaging 3 to 5 days. These data demonstrate that the majority of these patients can be managed with <24-hour hospitalization stays with similar complication rates as previously described in the literature.
Significance:
This study establishes a new paradigm for perioperative management of SCD children who undergo adenotonsillectomy.
Ebm Rating:
C-4.
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