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Complications of tonsillectomy and adenoidectomy in 9409 children observed overnight
Insights
Same-day discharge after adenoidectomy may be safe for children. However, significant post-tonsillectomy bleeding requires further study before establishing same-day discharge programs for all such procedures.
Area of Science:
- Pediatric Surgery
- Healthcare Management
Background:
- Physicians are reducing hospital stays to minimize healthcare costs.
- Traditionally, children undergoing adenoidectomy, tonsillectomy, or adenotonsillectomy were hospitalized overnight.
Purpose of the Study:
- To evaluate the safety and complication rates of overnight hospital stays for pediatric patients undergoing adenoidectomy, tonsillectomy, or adenotonsillectomy.
- To determine the feasibility of same-day discharge for children undergoing adenoidectomy.
Main Methods:
- Retrospective review of nursing records for 9409 patients aged 17 or younger.
- Analysis of complication rates, including postoperative bleeding and delayed discharges, between 1980 and 1984.
Main Results:
- 2.15% of patients experienced postoperative bleeding; 0.06% required a second anesthetic for hemostasis.
- 42 patients (0.45%) had discharge delayed due to bleeding; 57 patients (0.6%) for other reasons.
- Same-day discharge after 6 hours of observation may be safe for adenoidectomy alone, but not necessarily for adenotonsillectomy due to later bleeding.
Conclusions:
- Children undergoing adenoidectomy may be candidates for same-day discharge after 6 hours of observation.
- Further evaluation is needed to assess the efficacy of oral cavity examinations in reducing post-tonsillectomy hemorrhage before implementing same-day discharge for adenotonsillectomy.
- Delayed discharge for reasons other than bleeding was more common in very young and older children.
Abstract:
In attempts to minimize the cost of health care, physicians are reducing the duration of hospital stay. Traditionally, at the Hospital for Sick Children, Toronto, otherwise healthy children undergoing adenoidectomy, tonsillectomy or adenotonsillectomy have been admitted the morning of surgery and discharged from hospital at 7 am the next day. The nursing records of 9409 patients aged 17 years or less who were managed in this way between 1980 and 1984 were reviewed to determine the occurrence of complications during the observation period. A total of 202 patients (2.15%) bled during the observation period. Of the 202, 6 (0.06% of all the patients) required a second general anesthetic for hemostasis; 1 of these 6 patients and 5 others required blood transfusions. Discharge was delayed for 42 patients (0.45% of all the patients) because of postoperative bleeding and for 57 patients (0.6%) for a variety of other reasons. Delayed discharge for reasons other than hemorrhage was more frequent among children less than 2 years of age and those over 12 years of age. The authors concluded that children undergoing adenoidectomy could safely be discharged the same day after 6 hours of observation following surgery. However, as a substantial number of children bled from the tonsillar fossa more than 6 hours after surgery, the efficacy of periodic examination of the oral cavity during the observation period in reducing the rate of hemorrhage after 6 hours must be evaluated before a same-day discharge program is established for children undergoing adenotonsillectomy.