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Self-reported postoperative recovery in children after tonsillectomy compared to tonsillotomy
Mats Eriksson1, Ulrica Nilsson1, Ann-Cathrine Bramhagen2
1School of Health Sciences, Faculty of Medicine and Health, Örebro University, S-701 82 Örebro, Sweden.
Insights
Tonsil surgery recovery in children is better after tonsillotomy (TT) than tonsillectomy (TE). Patient-reported outcomes show TT leads to less morbidity and faster return to normal activities.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Patient-Reported Outcomes
Background:
- Tonsil surgery, including tonsillotomy (TT) and tonsillectomy (TE), is common in children.
- Postoperative recovery significantly impacts children's well-being and daily activities.
- Patient-reported outcome measures (PROMs) are crucial for assessing recovery and guiding care.
Purpose of the Study:
- To describe self-reported postoperative recovery in children after tonsil surgery.
- To compare the recovery experiences between tonsillotomy and tonsillectomy procedures.
Main Methods:
- 238 children (4-12 years) undergoing tonsil surgery were included.
- Procedures included partial tonsil resection/tonsillotomy (TT) or total tonsillectomy (TE).
- Postoperative recovery was assessed on days 1, 4, and 10 using the Postoperative Recovery in Children (PRiC) instrument.
Main Results:
- Recovery was affected by daily activities, physical symptoms (sore throat, otalgia, dizziness), and emotional aspects.
- Children undergoing TE reported worse recovery compared to those undergoing TT (p < 0.01-0.001).
- Older children (>6 years) reported more physical discomfort, while younger children experienced worse emotional states.
Conclusions:
- Children can effectively report their recovery experiences using validated instruments like PRiC.
- Tonsillotomy (TT) results in less postoperative morbidity and a quicker return to normal activities compared to tonsillectomy (TE).
- PROMs are essential for patient-centered care and optimizing postoperative management following pediatric tonsil surgery.
Objectives:
Tonsil surgery is associated with significant morbidity during recovery. Patient-reported outcome measures (PROM) are the golden standard for the planning and follow-up of delivered care, which should also be an axiom for children. The current aims were to describe self-reported postoperative recovery in children after tonsil surgery, and to compare tonsillotomy and tonsillectomy in this respect.
Methods:
In total, 238 children (4-12 years old) with a history of obstructive problems and/or recurrent tonsillitis, and undergoing tonsil surgery were included. Forty-eight per cent were operated with partial tonsil resection/tonsillotomy (TT) and 52% with total tonsillectomy (TE), all in day surgery. Postoperative recovery was assessed on days 1, 4 and 10 using the validated self-rating instrument PRiC, Postoperative Recovery in Children. This includes 23 items covering different aspects of recovery after tonsil surgery. A higher score indicates worse status in the respective items.
Results:
Daily life activities (sleeping, eating and playing), physical symptoms (e.g., headache, stomach ache, sore throat, otalgia, dizziness, nausea, defecation, urination), and emotional aspects (sadness, frightening dreams) were affected during the recovery period. The TE-girls showed higher scores than the boys regarding stomach ache, defecation and dizziness. Children above 6 years of age reported higher values for the physical comfort variables, while the younger group showed worse emotional states. Postoperative recovery improved from day 1-10 in all surgical groups. The TE-group showed lower recovery compared to the TT-group (p < 0.01-0.001) in most items.
Conclusion:
The goal of postoperative management is to minimize or eliminate discomfort, facilitating the recovery process and avoiding complications. Children are able to describe their recovery, and thus, PRiC seems to be able to serve as a PROM to obtain patient-centered data after tonsil surgery. The recovery process after TT causes less postoperative morbidity and a quicker return to normal activity compared to TE.