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Investigation of Postoperative Oral Fluid Intake as a Predictor of Postoperative Emergency Department Visits After
Matthew L Rohlfing1, Paul R Wistermayer1, Tayler M Bungo2
1Wake Forest School of Medicine, Winston-Salem, North Carolina.
Insights
Oral fluid intake before discharge does not predict emergency department visits after pediatric tonsillectomy. Discharge criteria based solely on fluid intake may be unnecessary, warranting further investigation.
Area of Science:
- Pediatric Otolaryngology
- Surgical Outcomes Research
- Patient Discharge Criteria
Background:
- Tonsillectomy is a common pediatric surgical procedure.
- Ensuring adequate hydration post-tonsillectomy is crucial for recovery and preventing complications.
- Current discharge practices may rely on fluid intake, but evidence for its predictive value is limited.
Purpose of the Study:
- To investigate the association between oral fluid intake before discharge and adverse outcomes after pediatric tonsillectomy.
- To determine if fluid intake volume is a reliable predictor of post-tonsillectomy complications requiring emergency department visits.
Main Methods:
- Retrospective cohort study of 473 pediatric patients undergoing tonsillectomy.
- Data collected from electronic medical records, focusing on oral fluid intake and post-discharge complications.
- Adverse outcomes included emergency department presentation, readmission, or return to the operating room within two weeks.
Main Results:
- Mean oral fluid intake was 18.2 mL/kg (range 0.7-66.7 mL/kg).
- 6.6% of patients presented to the emergency department with a related complication.
- No statistically significant correlation was found between oral fluid intake and emergency department presentation (OR, 1.03; P=.29).
Conclusions:
- Oral fluid intake prior to discharge is not a significant predictor of post-tonsillectomy emergency department visits in pediatric patients.
- Discharge criteria should not solely rely on arbitrary thresholds for oral fluid intake.
- Further multi-institutional studies or randomized clinical trials are recommended to generalize findings.
Importance:
This study contributes novel data on the association between oral fluid intake before discharge and adverse outcomes following tonsillectomy in pediatric patients. These data contribute to evidence-based, safe, and cost-effective decision making regarding discharge.
Objective:
To determine whether the quantity of oral fluid intake before discharge is associated with adverse outcomes following tonsillectomy in pediatric patients.
Design, Setting, And Participants:
A retrospective cohort analysis was conducted using the electronic medical records of 1183 pediatric patients undergoing tonsillectomy between September 24, 2012, and June 5, 2015, at a tertiary care academic medical center. Exclusion criteria included age 18 years or older, overnight admission, and missing data on fluid intake. The final cohort comprised 473 patients. Data analysis was conducted from July 8 to August 23, 2015.
Exposures:
All patients underwent tonsillectomy by 1 of 7 attending surgeons at our institution. All patients were given intravenous fluids and analgesia in the postanesthesia care unit before being admitted to the pediatric inpatient floor for monitoring before discharge.
Main Outcomes And Measures:
The primary outcome measured was presentation to the emergency department within 2 weeks after tonsillectomy with a related complication. We also recorded hospital readmissions and returns to the operating room for related complications. The primary diagnosis was noted for each complication.
Results:
Among 473 patients (235 male; mean [SD] age, 7.2 [3.5] years), oral fluid intake after tonsillectomy ranged from 0.7 to 66.7 mL/kg, with a mean (SD) intake of 18.2 (10.8) mL/kg. Mean (SD) time to discharge was 6.96 (1.91) hours (range, 1.68-14.25 hours). Overall, 31 patients (6.6%) presented to the emergency department for a related complication after tonsillectomy. No correlation was found between oral fluid intake after tonsillectomy and presentation to the emergency department (odds ratio, 1.03; 95% CI, 0.98-1.08; P = .29).
Conclusions And Relevance:
This study suggests that oral fluid intake before discharge is not predictive of presentation to the emergency department after tonsillectomy within the ranges studied and at this institution. Therefore, discharge criteria based strictly on thresholds for oral fluid intake may be unnecessary. Further study at multiple institutions using a wider range of fluid intake volumes or a large-scale randomized clinical trial is needed before conclusions can be generalized.
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