On the decision of outpatient adenoidectomy and adenotonsillectomy in children.
OBJECTIVE
Outpatient tonsillectomy and/or adenoidectomy is the procedure of choice in the US, whereas in Europe, the transition from the traditional duration of hospital stay to same day discharge slowly increases. This trial was conducted to find factors, which influence surgery on an outpatient basis and to find possible positive and negative predictive conditions in patients.


METHODS
Most trials, which argue for a same day discharge take the low percentage of postoperative hemorrhage into account. Hemorrhage, apnea and infections are complications and have to be distinguished from sequelae such as poor oral intake (with consecutive i.v. fluid supply), fever and protracted vomiting, that also should be considered as discharge criteria. Complications as well as sequelae were measured in 114 consecutive children, and the patients divided into an adenotonsillectomy group and an adenoidectomy group.


RESULTS
Patients from both groups that underwent surgery because of severe obstructive symptoms had significantly more sequelae than those indicated because of chronic or recurrent infections. They could not have been discharged in an acceptable condition. Due to the fact that most children after adenoidectomy recovered well 8 h postoperatively, they could have been discharged on the same day. Children after adenotonsillectomy had significantly more sequelae. There was a tendency that adenotonsillectomy children with only mild obstructions could have been discharged either 8 or at least 24 h postoperatively. It still remains the surgeon's decision when a child can be discharged safely.
Holzmann
D
D
Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich, CH-8091, Zurich, Switzerland. holzmann@orl.usz.ch
Kaufmann
T
T
Boesch
M
M
D000233:Adenoidectomy / Q000379:methods*; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D011336:Probability; D013557:Switzerland; D014068:Tonsillectomy / Q000379:methods*; D016896:Treatment Outcome