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CO2-Lasertonsillotomy Under Local Anesthesia in Adults
Published on: November 6, 2019
Revisit rates and diagnoses following pediatric tonsillectomy in a large multistate population
Sophie Shay1, Nina L Shapiro, Neil Bhattacharyya
1Department of Head and Neck Surgery, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California, U.S.A.
Insights
Pediatric tonsillectomy revisits occurred in 7.6% of cases, often due to pain or dehydration. Improving symptom management post-tonsillectomy could reduce these revisits.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Health Services Research
Background:
- Tonsillectomy and adenotonsillectomy are common pediatric procedures.
- Understanding post-operative revisit patterns is crucial for optimizing patient care and resource allocation.
Purpose of the Study:
- To investigate the incidence and characteristics of revisits after ambulatory pediatric tonsillectomy/adenotonsillectomy.
- To identify common diagnoses and outcomes associated with these revisits.
Main Methods:
- A cross-sectional study utilizing national databases (New York, Florida, Iowa, California).
- Analysis of ambulatory pediatric tonsillectomy/adenotonsillectomy cases from 2010.
- Tabulation of first and second revisits within 14 days, examining diagnoses, procedures, and mortality.
Main Results:
- Out of 36,221 cases, 7.6% had a first revisit and 1.1% had a second revisit.
- Most revisits (77.5%) were to the emergency department; bleeding occurred in 2.0% (first revisit) and 0.5% (second revisit).
- Primary diagnoses for revisits included acute pain (18.4%/11.2%) and fever/vomiting/dehydration (28.2%/17.9%).
Conclusions:
- This study highlights significant revisit rates following pediatric ambulatory tonsillectomy.
- Pain control and dehydration management are key areas for intervention to potentially reduce revisits.
- Findings provide insights into current outcomes, readmissions, and surgical interventions post-procedure.
Objectives/Hypothesis:
Investigate the incidence and characteristics of revisits following ambulatory pediatric tonsillectomy/adenotonsillectomy.
Study Design:
Cross-sectional study using national databases.
Methods:
Ambulatory pediatric (age <18.0 years) tonsillectomy or adenotonsillectomy cases were extracted from the 2010 State Ambulatory Surgery, Emergency Department, and Inpatient databases for New York, Florida, Iowa, and California. First and second revisits within the 14-day postoperative period were tabulated. Diagnoses, procedure codes, and mortality were examined.
Results:
There were 36,221 pediatric tonsillectomies/adenotonsillectomies (mean age 7.4 years, 51.4% male). Overall, 2,740 patients (7.6%) had a revisit after pediatric tonsillectomy; 402 patients (1.1%) had a second revisit. Among revisits, 6.3% revisited the ambulatory surgery center, 77.5% revisited the emergency department, and 16.2% were readmitted as an inpatient. Among all tonsillectomies, bleeding occurred in 2.0% and 0.5% within the first and second revisits, respectively. A second revisit had a statistically higher association with a primary bleeding diagnosis than the first revisit (P < .001). Among all cases, 0.75% underwent a surgical procedure for bleeding at a first revisit compared to 0.25% during a second revisit. Acute pain was the primary diagnosis in 18.4% and 11.2% of first and second revisits; fever/vomiting/dehydration were primary diagnoses in 28.2% and 17.9%, respectively. There were two mortalities (0.0055%) within the 14-day postoperative interval.
Conclusions:
This large-scale analysis describes the current rates and diagnoses of revisits, hospital readmission, and surgical intervention following ambulatory pediatric tonsillectomy. Many revisits centered on pain control and dehydration, suggesting that more adequate symptom control may prevent a large proportion of revisits.
Level Of Evidence:
2b.
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