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Day-case pediatric middle ear surgery: from myringoplasty to bilateral cochlear implantation
Harry R F Powell1, Richard G Rowlands, Jeremy A Lavy
1The Royal National Throat, Nose and Ear Hospital, London, United Kingdom. drharrypowell@msn.com
Insights
Pediatric tympanomastoid surgery, including mastoidectomy and cochlear implantation, can be safely performed as day cases. This approach offers a viable option for middle ear procedures, with all patients discharged on the same day.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Anesthesiology
Background:
- Limited evidence exists for safe and effective pediatric tympanomastoid day case surgery.
- Increasing pressure for financial targets and patient-centered care necessitates exploring day surgery options.
- Otolaryngologists may increase pediatric middle ear surgery on a day case basis.
Purpose of the Study:
- To evaluate the safety and efficacy of pediatric tympanomastoid surgery as day cases.
- To assess the feasibility of performing various middle ear procedures on a day case basis in children.
Main Methods:
- Prospective study of 52 consecutive pediatric patients undergoing tympanomastoid surgery at a London tertiary referral center.
- Procedures included myringoplasty, mastoidectomy, and cochlear implantation.
- Post-operative recovery was monitored, and anesthetic duration was compared to ward stay.
Main Results:
- No association was found between anesthetic duration and post-operative ward stay (r=-0.2203).
- All patients were discharged on the day of surgery, despite minor issues like pain and nausea.
- This series supports evidence for tympanoplasty and is the first for mastoid surgery as day cases.
Conclusions:
- Pediatric tympanomastoid surgery, including mastoidectomy and cochlear implantation, can be safely performed as day cases.
- Day case surgery is a viable and effective option for pediatric middle ear procedures.
- This approach aligns with patient-centered care and financial efficiency goals.
Objective:
In the English speaking literature there is very little evidence demonstrating safe and effective tympanomastoid day case surgery in pediatric practice. At a time when there is ongoing pressure for trusts to meet financial government targets and our care provision revolves around a patient centred approach, could otolaryngologists perform more pediatric middle ear surgery on a day case basis? We report our experience with a series of 52 pediatric middle ear day cases.
Method:
Prospective study from a London tertiary referral centre of 52 consecutive children undergoing tympanomastoid surgery. There were 6 categories of surgical procedure, ranging from myringoplasty to cochlear implantation. Post-operative recovery was monitored. The duration of anaesthesia was compared with the length of post-operative ward stay.
Results:
The correlation co-efficient r=-0.2203, showing that there was no association between length of anaesthetic and duration of post-operative ward stay.
Conclusions:
Despite minor post-operative problems including pain, bleeding, and nausea and vomiting all patients in this series were discharged on the day of surgery. For tympanoplasty our series adds weight to already available evidence. It is the first series showing that mastoid surgery, whether combined approach, traditional mastoidectomy or cochlear implantation can be performed safely as day cases in a pediatric population.
