Postoperative Complications in Pediatric Tonsillectomy and Adenoidectomy in Ambulatory vs Inpatient Settings

Amoils, Misha; Chang, Kay W.; Saynina, Olga; Wise, Paul H.; Honkanen, Anita

doi:10.1001/jamaoto.2015.3634

Cited by 58 publications

(61 citation statements)

References 30 publications

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“…Our study does have some significant limitations. Despite being the only tertiary children's hospital in the state, compared to the recent retrospective statewide review by Amoils et al, our 3‐year number is still relatively small. Likewise, the overall complication rate following tonsillectomy was expectedly low.…”

Section: Discussionmentioning

confidence: 69%

“…Interestingly, in their analysis, 33% of patients younger than 3 years old were not admitted after surgery despite these current guidelines. They therefore concluded that continued evaluation of which patients require admission following surgery is needed, and recommended that clinicians remain open to new information as it becomes available . An analysis out of the University of California Los Angeles of over 700 children undergoing tonsillectomy demonstrated no difference in complication rates between those <3 years old and those >3 years old .…”

Section: Introductionmentioning

confidence: 99%

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Revisiting age‐related admission following tonsillectomy in the pediatric population

et al. 2019

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Objectives/Hypothesis: The objectives of this study were to examine patient outcomes using a 36-month age cutoff as a strict admission criterion following tonsillectomy, and review the safety and determine the plausibility of same-day discharge of children under 3 years old following tonsillectomy.Study Design: Retrospective chart review. Methods: A chart review of patients aged 24 to 42 months undergoing tonsillectomy over a 3-year period was conducted. Patients were stratified into <36 months and ≥ 36 months cohorts. Data collected included demographics, medical/sleep history, inpatient records, 30-day emergency department visits, and readmission data. Bivariate comparisons were made using χ 2 and Wilcoxon tests for categorical and continuous variables.Results: Between July 2014 and July 2017, 427 patients aged 24 to 42 months underwent tonsillectomy at our institution. Thirty-day emergency department visit, readmission, and greater-than-expected length of stay rates were 3.0% versus 3.7% (P = .75), 1.0 versus 1.8% (P = .61), and 4.7% versus 4.5% (P = 1.00) between the younger and older cohorts, respectively, with no difference in complication rates identified based on age.Conclusions: No significant difference in adverse outcomes was appreciated based on a cutoff of 36 months of age at a tertiary center over 3 years. There should continue to be ongoing studies addressing strict age-related admission criteria.

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Section: Discussionmentioning

confidence: 69%

Section: Introductionmentioning

confidence: 99%

Revisiting age‐related admission following tonsillectomy in the pediatric population

et al. 2019

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“…[1][2][3][4] The rate of primary hemorrhage in pediatric tonsillectomy patients has been reported to be between 1.1% and 3.4%, whereas hemorrhage that required treatment in the operating room is reported to be between 0.5% and 2.1%, and emergency department (ED) visits for either pain or dehydration have been reported to be between 7.6% and 13.3%. [5][6][7][8] The costs of patient visits to the ED in these cases range from $1,104 to $1,737, and when averaged over all children undergoing adenotonsillectomy (including those who did visit the ED) adds, on average, $189 to each patient's care. 8 In light of this, there is a significant opportunity to optimize outcomes after tonsillectomy and reduce complications by maximizing safe pain control in a way that limits readmission or the need for clarifying phone calls to the physicians office after surgery.…”

Section: Introductionmentioning

confidence: 99%

The effect of postoperative steroids on post‐tonsillectomy pain and need for postoperative physician contact

et al. 2018

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“…Tonsillectomies are mainly performed for the treatment of adenotonsillar hypertrophy (resulting in sleep‐disordered breathing) and recurrent tonsillitis . However, despite its safe reputation, tonsillectomies are associated with significant risk of morbidity and delays to recovery . Post‐operative complications include bleeding, respiratory compromise, infection, dehydration, pain, nausea and vomiting .…”

mentioning

confidence: 99%

“…However, despite its safe reputation, tonsillectomies are associated with significant risk of morbidity and delays to recovery . Post‐operative complications include bleeding, respiratory compromise, infection, dehydration, pain, nausea and vomiting . These adverse events are associated with patient suffering and additional health resource utilisation associated with prolonged hospital admission and emergency presentations …”

mentioning

confidence: 99%

Impact of paediatric tonsillectomy perioperative management on pain, nausea and recovery: A prospective cohort study

Richards

Lang

Andresen

et al. 2019

J Paediatrics Child Health

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Aim: Tonsillectomy procedures are a core element of paediatrics; however, perioperative management differs. This study aimed to describe tonsillectomy management, including the burden of pain, nausea and delayed recovery. Methods: A prospective cohort study was undertaken through an audit of tonsillectomy perioperative practice and recovery and survey interviews with family members 7-14 days post-surgery. The study was undertaken at an Australian tertiary referral paediatric hospital between June and September 2016. Results: The audit included 255 children undergoing tonsillectomy, with 127 family members interviewed. Most participants underwent adenotonsillectomy (n = 216; 85%), with a primary diagnosis of obstructive sleep apnoea (n = 205; 80%) and a mean age of 7 years (standard deviation; 3.9). A variety of intra-operative pain relief and antiemetics was administered. Pain was present in 29% (n = 26) of participants at ward return, increasing to 32-45% at 4-20 h and decreasing to 21% (n = 15) at discharge. A third of the children (32%; n = 41) had moderate to severe pain at post-discharge interview, and 30% (n = 38) experienced nausea at home. Most parents (82%; n = 104) were still giving regular paracetamol at 7 days post-operatively, and 31% (n = 39) had finished their oxycodone. Of the participants, 14% (n = 26) presented to the emergency department within 7 days of discharge; 8% (n = 20) of the total cohort were re-admitted. Conclusions: There was variety in perioperative and post-discharge care. Pain scores were infrequently documented post-tonsillectomy, and parents are generally dissatisfied with the management of post-operative pain and nausea. Further research is needed to provide a more consistent approach to perioperative management to promote recovery.What is already known on this topic 1 Tonsillectomy is a commonly performed procedure in children. 2 Significant risk of morbidity and delays to recovery continue to exist. 3 Post-operative pain, nausea and vomiting, bleeding and infection remain problematic, contributing to re-presentation to emergency departments and readmission rates. What this paper adds1 Pain scores are infrequently documented post-tonsillectomy. 2 Parents are generally dissatisfied with the management of postoperative pain and nausea, and the majority of our participants sought additional information from either their local pharmacy or general practitioner post-discharge. 3 Enhanced parental pre-operative education focusing on pain management may benefit children's outcomes.Tonsillectomy, with and without adenoidectomy, is a frequently performed surgical procedure for children world-wide. 1,2 Tonsillectomies are mainly performed for the treatment of adenotonsillar hypertrophy (resulting in sleep-disordered breathing) and recurrent tonsillitis. 1,3 However, despite its safe reputation, tonsillectomies are associated with significant risk of morbidity and delays to recovery. 2,4,5 Post-operative complications include bleeding, respiratory compromise, infection, dehydration, pain,...

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Postoperative Complications in Pediatric Tonsillectomy and Adenoidectomy in Ambulatory vs Inpatient Settings

Cited by 58 publications

References 30 publications

Revisiting age‐related admission following tonsillectomy in the pediatric population

Revisiting age‐related admission following tonsillectomy in the pediatric population

The effect of postoperative steroids on post‐tonsillectomy pain and need for postoperative physician contact

Impact of paediatric tonsillectomy perioperative management on pain, nausea and recovery: A prospective cohort study

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