Day stay pediatric tonsillectomy--a safe procedure.
OBJECTIVE
There is a controversy about day stay pediatric tonsillectomy in the UK and Australia. New Zealand has a similar health structure and we wished to compare day stay tonsillectomy from our hospital with those reported from other centers.


METHODS
We performed a prospective audit of day stay tonsillectomy to determine conversion to hospital admission rate and the incidence of postoperative hemorrhage.


RESULTS
There were 4850 paediatric tonsillectomies performed with 80% of them as day stay procedures over a 9-year study period (1993-2002) in a university-affiliated tertiary children's hospital. The primary postoperative hemorrhage rate (within 24h of surgery) was 0.9% (CI 0.68-1.22%) and 83% occurred within the mandatory 4h postoperative observation period. Primary hemorrhage requiring re-operation to achieve hemostasis occurred in 18 children (0.37%, CI 0.2-0.54%). No child with a primary hemorrhage who presented after discharge following day stay surgery required re-operation or blood transfusion. Day stay surgery was planned in 4041 children and 4.7% (CI 4.1-5.4%) required conversion to hospital admission. Postoperative vomiting was the most common indication for conversion (2.65%, CI 2.2-3.1%), while hemorrhage contributed only 0.95% (CI 0.64-1.24%).


CONCLUSIONS
This study was performed in a health system similar to that of Australia and the UK. Complication and conversion rates are similar to those reported in North American centers. Pediatric day stay tonsillectomy is a safe procedure when performed with strict preoperative criteria, trained day stay unit (DSU) staff, and with in-patient facilities on site.
Mills
Nikki
N
Department of Pediatric Otolaryngology, Auckland Children's Hospital, Park Road, Auckland, New Zealand.
Anderson
Brian J
BJ
Barber
Colin
C
White
Julian
J
Mahadevan
Murali
M
Salkeld
Leslie
L
Douglas
Gavin
G
Brown
Colin
C
D000293:Adolescent; D017677:Age Distribution; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003681:Dehydration / Q000453:epidemiology; D006487:Hemostasis; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008485:Medical Audit; D009020:Morphine / Q000627:therapeutic use; D009520:New Zealand / Q000453:epidemiology; D010149:Postoperative Pain / Q000517:prevention & control; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000601:surgery; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D011446:Prospective Studies; D012086:Reoperation / Q000706:statistics & numerical data; D014068:Tonsillectomy / Q000706:statistics & numerical data*
D000701:Analgesics, Opioid; D009020:Morphine