Post-operative nausea and vomiting following paediatric day-case tonsillectomy: audit of the Epsom protocol

Area of Science:

• Otolaryngology
• Pediatric Surgery
• Anesthesiology

Background:

• Elective, day-case pediatric Ear, Nose, and Throat (ENT) surgery protocols aim for high same-day discharge rates.
• Previous reports indicated a 2% post-operative nausea and vomiting (PONV) rate and 100% discharge rate for this surgical cohort.
• Auditing established protocols is crucial for validating patient safety and procedural efficiency.

Purpose of the Study:

• To audit an established protocol for elective, day-case pediatric ENT surgery.
• To verify the previously reported low rates of post-operative nausea and vomiting (PONV) and high same-day discharge rates.
• To assess the safety and efficacy of the protocol in a contemporary cohort.

Main Methods:

• The audit included 91 pediatric patients (45 boys, 46 girls) aged 3–14 years undergoing tonsillectomy, adenotonsillectomy, or tonsillectomy with postnasal space examination.
• Indications for surgery included recurrent tonsillitis, tonsillitis with nasal block, upper airway obstruction, and combined conditions.
• Data collection focused on post-operative nausea/vomiting, discharge timing, and hemorrhage rates.

Main Results:

• Zero instances of post-operative nausea or vomiting were recorded on the day of surgery.
• All 91 children were discharged on the same day, with no delays.
• The reactionary hemorrhage rate was 1%, and the secondary hemorrhage rate was 3.3%.

Conclusions:

• The audited protocol supports the safe same-day discharge of pediatric patients following elective tonsillectomy and related procedures.
• The findings reinforce the feasibility of day-case surgery for pediatric ENT, with minimal PONV and low hemorrhage risks.
• This protocol has significant implications for optimizing pediatric surgical care and resource utilization.