Impact of Nurse-Led Versus Surgeon-Led Preoperative Counseling and Follow-Up on Postoperative Outcomes in Pediatric Tonsillectomy: A Longitudinal Observational Study
1Department of Otolaryngology and Stomatology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
Insights
Nurse-led care significantly reduces post-tonsillectomy pain and complications in children. This approach improves patient satisfaction and clinical outcomes compared to surgeon-led or no-counseling groups.
Area of Science:
- Pediatric surgery
- Nursing care
- Pain management
Background:
- Tonsillectomy in children presents challenges in surgical preparation and managing post-operative pain and complications.
- Existing care models may not adequately address the complex needs of pediatric patients undergoing tonsillectomy.
Purpose of the Study:
- To compare postoperative pain intensity and complication rates in children after tonsillectomy based on different pre-operative counseling and post-operative follow-up strategies.
- To evaluate the impact of nurse-led versus surgeon-led care on patient outcomes and satisfaction.
Main Methods:
- A comparative study involving three groups of children undergoing elective tonsillectomy: nurse-led counseling and follow-up (NCC), surgeon-led counseling and follow-up (FSS), and usual surgeon visits (UUS).
- Outcomes assessed included pain levels, complication frequencies (fever, anxiety, vomiting), medication needs (tramadol), hospital stay duration, oral intake, and patient satisfaction over a 6-month follow-up period.
Main Results:
- The Nurse-led Counseling (NCC) cohort experienced significantly less post-tonsillectomy pain, fewer complications (anxiety, vomiting), reduced need for tramadol, shorter hospital stays, and higher satisfaction compared to FSS and UUS cohorts.
- All children reported some nausea, and 55% experienced decreased oral intake during follow-up.
- Pain at discharge and one month post-surgery was reported, with NCC showing better pain management.
Conclusions:
- Post-tonsillectomy pain and decreased oral intake are common in children and can exceed expectations.
- Nurse-led counseling and follow-up care demonstrate superior outcomes, including reduced pain and complications, and enhanced patient satisfaction for children undergoing tonsillectomy.
Abstract:
BACKGROUND Pre-tonsillectomy complex challenges in explaining surgeries requirements and preparing children for curative surgeries. In addition, post-tonsillectomy pain and complications are reported in children with tonsillitis. The objective of the study was to compare the intensities of postoperative pain and frequencies of postoperative complications among children undergoing elective tonsillectomy who received different types of counseling and follow-up care. MATERIAL AND METHODS Children received pre-tonsillectomy nurse-led counseling and post-tonsillectomy nurse-led follow-up care for 6 months (NCC cohort, n=29), pre-tonsillectomy surgeon-led counseling and post-tonsillectomy surgeon-led follow-up care for 6 moths (FSS cohort, n=35), or did not receive counseling and received everyday surgeons' visits during hospital stays only (UUS cohort, n=38). RESULTS Post-tonsillectomy pain was 4 (IQ range, 5-4) per child at discharge from the hospital. The children reported mild pain during the 1-month follow-up. Children in the NCC cohort had fever, post-tonsillectomy pain at discharge and 1 months after surgeries, needed less tramadol, had fewer hospital stays, had fewer immediate and late post-tonsillectomy complications (especially anxiety and vomiting), and had higher personal satisfaction and higher clinical benefits than children in the FSS and UUS cohorts (P<0.05). Nausea was reported in all children. A total of 56 (55%) children had a decrease in oral intake during the follow-up period. CONCLUSIONS Children may experience more post-tonsillectomy pain than expected at discharge and during follow-up. After tonsillectomy, children had a decrease in oral intake. Nurse-led counseling and follow-up care have favorable post-tonsillectomy outcomes and high personal satisfaction of children undergoing curative tonsillectomies.
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