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Evaluation of day-care tonsil surgery in young children
Andrea M Bruaset1, Michael Dahlstrøm, Sören Möller
1anette.kjeldsen@rsyd.dk.
Insights
Tonsil surgery in children under 4 years old can be safely performed as day surgery. While younger children had more non-bleeding complications, older children experienced higher rates of hemorrhage and readmission.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Health Services Research
Background:
- Current guidelines recommend inpatient admission for children under 4 undergoing tonsil surgery.
- This study evaluates the safety of day surgery for tonsillectomy in young children.
Purpose of the Study:
- To assess the safety and outcomes of day surgery for tonsillectomy in children aged 4 years and younger.
- To compare complication rates between younger (≤ 4 years) and older (> 4 years) pediatric patients undergoing tonsil surgery.
Main Methods:
- Retrospective cohort study of 414 patients (aged 2-15 years) undergoing tonsillectomy, adenotonsillectomy, or tonsillotomy.
- Reviewed patient charts for post-operative complications including hemorrhage, unplanned contacts, and hospital revisits.
Main Results:
- Hemorrhage occurred in 5.7% of patients, with higher rates in those over 4 years old.
- Patients aged 4 years and younger had more non-bleeding related unplanned contacts (pain, medication issues).
- Older patients (> 4 years) showed significantly higher rates of hemorrhage, readmission, and secondary surgery.
Conclusions:
- Tonsil surgery as day surgery appears safe for children aged 4 years and younger.
- While younger children experience more non-hemorrhagic complications, older children have higher rates of serious bleeding and readmission.
- Ensuring easy telephone access to hospital staff is crucial for reassuring caregivers post-surgery.
Introduction:
The National Clinical Guideline for Ton-sillectomy (Danish Health Authority, 2016) suggests inpatient admission after elective tonsil surgery in patients aged < 4 years at the time of surgery. We aimed to evaluate the safety of tonsil surgery as day surgery in children ≤ 4 years of age.
Methods:
The charts of 414 patients aged 2-15 years who underwent elective tonsillectomy, adenotonsillectomy or tonsillotomy at Svendborg Hospital, Denmark, from February 2010 to April 2015 were reviewed in a retrospective cohort. We investigated post-operative complications, defined as post-operative haemorrhage and unplanned contacts or revisits to the hospital.
Results:
A total of 389 patients were divided into two groups by age (≤ 4/> 4 years). In all, 108 patients contacted or revisited the hospital after discharge. Patients aged ≤ 4 years accounted for the majority of contacts unrelated to bleeding and associated with complaints of pain and pain medication. Haemorrhage occurred in 22 (5.7%) patients, 19 of whom were > 4 years. The rates of haemorrhage, readmission and secondary surgery were significantly higher in patients aged > 4 years than in the remaining patients.
Conclusions:
Patients ≤ 4 years experienced significantly less haemorrhage but had more unplanned contacts than patients > 4 years. For reassurance of caretakers, easy access to telephone contact with hospital staff in the post-operative period is important.
Funding:
none.
Trial Registration:
not relevant.
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