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Daycare tonsillectomy and/or adenoidectomy at the British Columbia Children's Hospital
K Riding1, B Laird, G O'Connor
1Department of Surgery, University of British Columbia, Vancouver, Canada.
Insights
Daycare tonsillectomy and adenoidectomy are safe for children. British Columbia Children
Area of Science:
- Pediatric Otolaryngology
- Outpatient Surgery
- Healthcare Management
Background:
- Tonsillectomy (T) and adenoidectomy (A) are commonly performed pediatric surgical procedures.
- Daycare or outpatient surgery offers potential benefits for selected pediatric patients undergoing T or T & A.
- Establishing the safety and efficacy of daycare T & A procedures is crucial for healthcare providers.
Purpose of the Study:
- To evaluate the safety and feasibility of implementing daycare tonsillectomy (T) and adenoidectomy (A) procedures at British Columbia Children's Hospital (B.C.C.H.).
- To outline the systematic approach adopted by B.C.C.H. to ensure the safe execution of outpatient T & A.
- To transition daycare T & A from pilot projects to routine surgical practice.
Main Methods:
- Initiation of a pilot project for daycare adenoidectomies (A) in 1984, followed by a second pilot for daycare tonsillectomies (T) or tonsillectomy with adenoidectomy (T & A) in 1988.
- Development and implementation of strict criteria for patient selection, pre-operative preparation, anesthesia, post-anesthetic recovery (PAR), Daycare Unit (DCU) nursing care, and discharge protocols.
- Systematic collection and analysis of follow-up information to assess patient outcomes and procedural safety.
Main Results:
- The initial pilot project for daycare adenoidectomies proved successful, leading to broader adoption.
- The subsequent pilot for daycare tonsillectomies (or T & A) also demonstrated safety and efficacy.
- Established protocols and criteria facilitated the safe integration of daycare T & A into routine practice at B.C.C.H.
Conclusions:
- Daycare tonsillectomy (T) and adenoidectomy (A) are safe and viable procedures for selected pediatric patients.
- The structured approach implemented at B.C.C.H., including pilot projects and defined criteria, ensured successful adoption of outpatient T & A.
- Daycare tonsillectomy with or without adenoidectomy and daycare adenoidectomy are now established routine procedures at B.C.C.H.
Abstract:
The fact that tonsillectomy (T), or tonsillectomy with adenoidectomy (T & A) or adenoidectomy (A) can be performed safely in selected children on a daycare or outpatient basis is well proven. This article illustrates the approach that the British Columbia Children's Hospital (B.C.C.H.) took to confirm that the procedures were safe locally. A pilot project was started in June of 1984 to perform daycare adenoidectomies only, using two full-time pediatric otolaryngologists. When this proved successful, other otolaryngologists were encouraged to use the program. In June of 1988, a second pilot project was started for daycare tonsillectomies (or tonsillectomy and adenoidectomy). Criteria were established for patient selection, preparation, anesthesia, post-anesthetic recovery (PAR), Daycare Unit (DCU) nursing, and discharge. Follow-up information was obtained. Daycare tonsillectomy with or without adenoidectomy and daycare adenoidectomy are now routine procedures at B.C.C.H.