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Failures in outpatient tonsillectomy policy in children: a retrospective study in 311 children
1Service d'Oto-Rhino-Laryngologie, de Chirurgie Cervico-Faciale et de Phoniatrie, Hopital Edouard Herriot, Lyon, France.
Insights
Outpatient tonsillectomy in children is generally safe, but some patients require overnight hospital stays due to complications or specific health and social factors. Careful patient selection and parental education are crucial for successful ambulatory surgery.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Health Services Research
Background:
- Outpatient tonsillectomy is considered safe and cost-effective in children.
- Recent studies highlight potential contraindications for ambulatory surgery in select pediatric populations.
Purpose of the Study:
- To evaluate the success rates and identify factors influencing the failure of outpatient tonsillectomy in children.
- To compare outcomes between different patient groups and age categories.
Main Methods:
- Retrospective study of 311 children undergoing tonsillectomy.
- Categorization into two groups: planned inpatients and scheduled outpatients.
- Analysis of reasons for inpatient admission and complications leading to overnight stay.
Main Results:
- 11.6% of scheduled outpatients required overnight hospital supervision due to complications, primarily bleeding.
- Factors leading to failed outpatient policy included preoperative health issues, sleep apnea, major concurrent procedures, unreliable social environments, and parental refusal.
- No significant age-related difference in overnight supervision was observed between children under 4 and older children, after accounting for medical and social factors.
Conclusions:
- Children with significant medical comorbidities or inadequate social support require inpatient management for tonsillectomy.
- Ambulatory tonsillectomy is feasible for other children, provided parents are informed about the potential need for overnight observation (11.6% of cases).
- Preexisting medical and social conditions are key contraindications for ambulatory surgery, irrespective of age.
Abstract:
The literature suggests that outpatient tonsillectomy in children is a safe and cost-effective procedure. These conclusions have been based on the low rate of post-operative complications. Recent papers suggest contra-indications for ambulatory surgery in some patients. A retrospective study involving 311 children was performed in our Department. We defined two groups in which the out-patient policy had failed. The first group (43 children) comprised inpatient children scheduled because of an unhealthy preoperative state (12 patients), a sleep-apnea syndrome (5 children), a major associated procedure (3 patients), a social or family environment not reliable enough for postoperative supervision (19 patients) or because of parental refusal (4 patients). The second group (268 patients) was constituted of scheduled outpatients. In this group, the outpatient policy failed in 31 and children had to be kept overnight, because complications occurred. The main short-term complication was bleeding (13 patients). In 8, delayed complications were observed. Thus, according to the literature, children with concomitant heavy medical problems or with a poor social environment have to be managed as inpatients. For the others outpatient procedures were possible but parents should previously be informed of the possible overnight hospital supervision which is needed in 11.6% of cases. When comparing the youngest patients under 4 years of age with the others, although the preexisting medical and social conditions are important factors that may contraindicate ambulatory surgery, once the latter has been decided on, there is no significant difference between the two age groups regarding the number of children requiring overnight hospital supervision.