title: Peri-operative management of high-risk paediatric adenotonsillectomy patients: A survey of 35 UK tertiary referral centres.
abstract: BACKGROUND
  Peri-operative management of high-risk paediatric patients undergoing adenotonsillectomy for treatment of obstructive sleep apnoea varies between tertiary referral hospitals. 'Day of surgery cancellation' (DoSC) rates of up to 11% have been reported due to pre-booked critical care being unavailable on the day of surgery as a result of competing needs from other hospital departments. We report the results of a survey of peri-operative management in UK tertiary care centres of high-risk paediatric patients undergoing adenotonsillectomy for obstructive sleep apnoea (OSA).
  
  
  METHODS
  An 8-point questionnaire was developed using a cloud-based software platform (www.surveymonkey.com). A web-link to the survey was embedded in a customised e-mail which was sent via secure server to the Clinical Leads for Paediatric Otolaryngology at 35 United Kingdom (UK) Tertiary referral centres.
  
  
  RESULTS
  The survey response rate was 60% (n = 21). Almost all (94.1%) of centres considered paediatric critical care facilities to be limited, with 70.6% (n = 12) stating that DoSC often occurred due to unavailable paediatric critical care capacity. There was variation between tertiary referral units in the practice applied for pre-booking critical care beds (our survey identifies 6 variations) (Table 1). The most frequent selection method reported (47.1%) was at the discretion of the booking clinician at the time of listing the patient for surgery.
  
  
  CONCLUSIONS
  In the context of limited critical care resources, variation in practice and difficulty in accurately predicting which patients will require post-operative critical care beds, a review and consensus on best practice in the peri-operative management of high risk paediatric adenotonsillectomy patients may offer a safe means of reducing cancellations and improving patient care, resource allocation and hospital efficiency.
authors.affiliation: Broomfield Hospital, Mid Essex Hospital Services NHS Trust, Court Road, Broomfield, Chelmsford CM1 7ET, United Kingdom. Electronic address: chintaw.cheong@nhs.net.
authors.forename: Ryan Chin Taw
authors.initials: RC
authors.lastname: Cheong
authors.affiliation: Brighton and Sussex University Hospitals, Eastern Road, Brighton BN2 5BE, United Kingdom.
authors.forename: Philippe
authors.initials: P
authors.lastname: Bowles
authors.affiliation: Brighton and Sussex University Hospitals, Eastern Road, Brighton BN2 5BE, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Moore
authors.affiliation: Brighton and Sussex University Hospitals, Eastern Road, Brighton BN2 5BE, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Watts
mesh_terms: D000233:Adenoidectomy / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D019990:Perioperative Care / Q000379:methods; D012017:Referral and Consultation; D012306:Risk; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers; D014068:Tonsillectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D006113:United Kingdom
keywords: Adenotonsillectomy; Critical care; Obstructive sleep apnoea; Paediatric; Peri-operative