title: Revisit rates and diagnoses following pediatric tonsillectomy in a large multistate population.
abstract: OBJECTIVE
  Investigate the incidence and characteristics of revisits following ambulatory pediatric tonsillectomy/adenotonsillectomy.
  
  
  METHODS
  Cross-sectional study using national databases.
  
  
  METHODS
  Ambulatory pediatric (age <18.0 years) tonsillectomy or adenotonsillectomy cases were extracted from the 2010 State Ambulatory Surgery, Emergency Department, and Inpatient databases for New York, Florida, Iowa, and California. First and second revisits within the 14-day postoperative period were tabulated. Diagnoses, procedure codes, and mortality were examined.
  
  
  RESULTS
  There were 36,221 pediatric tonsillectomies/adenotonsillectomies (mean age 7.4 years, 51.4% male). Overall, 2,740 patients (7.6%) had a revisit after pediatric tonsillectomy; 402 patients (1.1%) had a second revisit. Among revisits, 6.3% revisited the ambulatory surgery center, 77.5% revisited the emergency department, and 16.2% were readmitted as an inpatient. Among all tonsillectomies, bleeding occurred in 2.0% and 0.5% within the first and second revisits, respectively. A second revisit had a statistically higher association with a primary bleeding diagnosis than the first revisit (P < .001). Among all cases, 0.75% underwent a surgical procedure for bleeding at a first revisit compared to 0.25% during a second revisit. Acute pain was the primary diagnosis in 18.4% and 11.2% of first and second revisits; fever/vomiting/dehydration were primary diagnoses in 28.2% and 17.9%, respectively. There were two mortalities (0.0055%) within the 14-day postoperative interval.
  
  
  CONCLUSIONS
  This large-scale analysis describes the current rates and diagnoses of revisits, hospital readmission, and surgical intervention following ambulatory pediatric tonsillectomy. Many revisits centered on pain control and dehydration, suggesting that more adequate symptom control may prevent a large proportion of revisits.
  
  
  METHODS
  2b.
authors.affiliation: Department of Head and Neck Surgery, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California, U.S.A.
authors.forename: Sophie
authors.initials: S
authors.lastname: Shay
authors.forename: Nina L
authors.initials: NL
authors.lastname: Shapiro
authors.forename: Neil
authors.initials: N
authors.lastname: Bhattacharyya
mesh_terms: D000293:Adolescent; D000556:Ambulatory Surgical Procedures; D002648:Child; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D014068:Tonsillectomy; D014481:United States / Q000453:epidemiology
keywords: Tonsillectomy; dehydration; outpatient; pain; pediatric; postoperative hemorrhage; readmission; revisit; safety; surgical complications