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Oral fluid intake following tonsillectomy
1Department of Otolaryngology, Hospital For Sick Children, Toronto, Ontario, Canada.
Insights
Discharging pediatric tonsillectomy patients without mandatory fluid intake is safe and efficient. This approach reduces hospital stay and improves same-day discharge rates without increasing dehydration risks.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Health Economics
Background:
- Tonsillectomy patients traditionally require pre-discharge fluid intake.
- Same-day discharge is increasingly common due to economic pressures.
- Previous studies support same-day discharge safety for select children.
Purpose of the Study:
- To evaluate the impact of mandatory oral fluid intake on same-day discharge tonsillectomy outcomes.
- To assess the safety and economic efficiency of removing pre-discharge fluid requirements.
Main Methods:
- A non-randomized cohort study of 200 pediatric tonsillectomy patients undergoing same-day discharge.
- Group 1 (100 patients) had a mandatory 20 cc/kg fluid intake requirement.
- Group 2 (100 patients) had no mandatory fluid intake requirement.
Main Results:
- Mean oral fluid intake significantly decreased in Group 2 (130 cc) vs. Group 1 (524 cc).
- Mean length of stay significantly reduced in Group 2 (10.0 h) vs. Group 1 (13.8 h).
- Same-day discharge on time increased from 71% in Group 1 to 94% in Group 2; no readmissions for dehydration occurred.
Conclusions:
- Eliminating mandatory pre-discharge fluid intake is safe for pediatric tonsillectomy patients.
- This practice enhances economic efficiency by reducing length of stay and improving discharge rates.
- Same-day discharge is feasible prior to the resumption of normal oral fluid intake.
Abstract:
Children undergoing tonsillectomy surgery traditionally have been required to drink a specified amount of fluid before being discharged home. With increasing economic pressures, same-day discharge tonsillectomy has become common, and several studies have shown it to be safe for the appropriately selected child. To examine the role of required oral fluid intake following tonsillectomy, a non-randomized cohort study was performed with 200 consecutive tonsillectomy patients scheduled for same-day discharge. The first 100 patients (group 1) were required to drink 20 cc/kg prior to discharge, and the next 100 patients (group 2) were not required to drink. The mean oral fluid intake prior to discharge decreased significantly between the two groups from 524 cc in group 1 to 130 cc in group 2 (P = 0.0001). The mean length of stay also decreased significantly from 13.8 h for group 1 to 10.0 h for group 2 (P = 0.0001). Sixty percent of children in each group vomited at least once following surgery. Fewer children in group 2 had protracted vomiting (8 versus 15) although this was not statistically significant (P = 0.12). No children were readmitted to the hospital for dehydration following discharge. Overall, 71% of children in group 1 scheduled to go home the same day were discharged on time, compared to 94% of children in group 2. In conclusion, it is safe and economically efficient to discharge tonsillectomy patients home prior to the resumption of normal oral fluid intake.