The effect of postoperative steroid dosing on readmission rates following radiofrequency ablation tonsillectomy

To examine the effect of postoperative steroid dosage on postoperative telephone calls, emergency department (ED) visits, and hemorrhage rates for two groups receiving different steroid dosing following radiofrequency ablation tonsillectomy.

Retrospective chart review between January 1, 2014 and January 1, 2019.

Tertiary care pediatric hospital.

Two postoperative steroid dosing protocols studied: 1) three postoperative doses of 0.5 mg/kg dexamethasone, or 2) three postoperative doses of 4 mg dexamethasone. Otherwise, postoperative care and pain control were similar for all patients. We hypothesized that standardized steroid dosing would achieve similar postoperative outcomes when compared to weight-based dosing with regards to patient phone calls, ED visits, readmission rates, and bleeding rates.

Overall, 279 patients were included (n = 100 at 4 mg, n = 179 at 0.5 mg/kg). There were no differences between groups in age, gender, race, BMI, or comorbidities (P > 0.05). Readmission and ED visit rates were 2.8% and 12.2% respectively, with no significant difference between groups (P > 0.05)). The overall hemorrhage rate was 6.3%, including those patients presenting to the ED but not requiring intervention for bleeding concerns. There was no difference in hemorrhage rates between groups (P = 0.22); the hemorrhage rate requiring operative intervention was 1.4% with no difference between groups (P = 0.27). Postoperative phone calls to physicians' office occurred in 13.3% of cases with no difference between groups (P = 0.41).

Comparable rates of readmission, ED visits, hemorrhage, and patient phone calls were seen with a standard dose of 4 mg versus 0.5 mg/kg weight-based dosing of a short course of postoperative dexamethasone following radiofrequency ablation tonsillectomy.