Adult Tonsillectomy as a Day care Procedure - Our Experience (original) (raw)

Post tonsillectomy haemorrhage: "is day care surgery safe"?

JPMA. The Journal of the Pakistan Medical Association, 2009

To compare the frequency of haemorrhage after tonsillectomy as a day care procedure versus tonsillectomy as a one day procedure. A comparative study was conducted at the Department of ENT and Head and Neck Surgery, Shifa International Hospital, Islamabad from January 2003 to December 2007. The sample consisted of 400 patients, divided into two groups, One group was kept in the hospital for eight hours and was labeled as the daycare group while other group was kept admitted for 23 hours stay (overnight) and was labeled as the one day group. Patients with nasal pathology, bleeding diathesis and less than 4 years of age were excluded. Patients were followed up post operatively on 7th and 14th day and were inquired about any bleeding episode from the mouth during stay at home. The data was analysed at SPSS 13. Post tonsillectomy haemorrhage was seen in 10 patients (2.5%), 4 (2%) occurred in day care group while 6 (3%) in one day group. All were secondary haemorrhages. Chi square test sh...

Comparison of three techniques in adult tonsillectomy

European Archives of Oto-Rhino-Laryngology, 2012

This study aimed at investigating the thermal welding (TW), classic dissection (CD) and bipolar cautery dissection (BCD) tonsillectomy in adults. 120 adults with chronic tonsillitis, who were scheduled for elective tonsillectomy between January 2009 and April 2012, were randomized to tonsillectomy with the TW, CD and BCD methods. Operation time, intraoperative blood loss, postoperative haemorrhage rate and especially post-operative pain were evaluated. The difference between operative time of the TW and BCD groups against CD group was statistically significant (p \ 0.05). The difference between intraoperative blood loss of the TW and BCD groups against CD group was statistically significant (p \ 0.05). No significant difference was found in the incidence of post-tonsillectomy haemorrhage between the three groups (p [ 0.05). The difference between post-operative pain score between CD and TW was not statistically significant (p [ 0.05). The difference between post-operative pain score of the two groups against BCD group was statistically significant (p \ 0.05). TW technique is a relatively safe and reliable method with significantly less post-operative morbidity than CD and BCD tonsillectomy. When we compared TW with the CD and BCD tonsillectomy, we found significant reduction in the surgical time and the intraoperative blood loss without any increase in the postoperative pain.

Indication of Adult Tonsillectomy & Postoperative Complication According to Indications

Background: Tonsillectomy remains the most common surgical procedure in field of otolaryngology, and it has a wide range of techniques, indications and complications. Aim of the study: To determine the indications of adult tonsillectomy and the postoperative complications in relation to each indication. Patients and methods: A prospective study of 180 adult patients aged 18-70 years underwent tonsillectomy kept under close observation for analysis. Results: In the study, the most common indication of surgery was acute recurrent tonsillitis (74%), upper airway obstruction (11.1%), suspected neoplasm (8.8) and post-quinsy (5.5%) respectively. The incidence of complications varies according to the indication, patients underwent tonsillectomy for acute recurrent tonsillitis had increased incidence of postoperative bleeding and uvular edema, while patients underwent tonsillectomy for upper airway obstruction had increased incidence of prolonged hospitalization and dyspnea.

Day stay pediatric tonsillectomy—a safe procedure

International Journal of Pediatric Otorhinolaryngology, 2004

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 24 h of surgery) was 0.9% (CI 0.68-1.22%) and 83% occurred within the mandatory 4 h 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 reoperation 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.

Safety of day-stay tonsillectomy

Indian Journal of Otolaryngology and Head & Neck Surgery, 2010

The appropriateness of tonsillectomy as a day case procedure is not universally accepted, however, the procedure has been performed in our institution since 1996. Our policy has been to continue this practice.

Day-case tonsillectomy: practical solution or practical impossibility

Irish medical journal, 2015

The use of day case surgery is on the rise. In order to improve efficiency and reduce cost, it has been proposed that tonsillectomy could be undertaken as a day-case procedure in Ireland. A retrospective, chart-based study was carried out. The medical and social criteria of all patients who underwent tonsillectomy during a twelve-month period were evaluated. Individual, local and national factors were identified and international comparisons were made. Of 161 patients included, 43 (27%) were considered suitable for day case tonsillectomy (DCT). The distance/time criteria from hospital excluded 64% of patients. The diagnosis of obstructive sleep apnoea was the single most common medical reason for exclusion. Support structures were deficient. Local factors must be considered before any policy or targets are developed for DCT. Patient safety is the fundamental tenet. Currently, the infrastructure and the support required for a patient-focused, safe efficient DCT are deficient, and nee...

Tonsillectomy in Paediatric Population

The Professional Medical Journal, 2016

Objectives: To compare mean operative time and Intra operative blood lossbetween bipolar electro dissection and cold dissection tonsillectomy in paediatric population.Study Design: Randomized controlled trial. Place and Duration: Department of ENT and Headand Neck Surgery, Continental Medical College, Hospital Lahore, from 1 January 2015 to 30September 2015. Materials and Methods: This study included 164 patients of age group 4 to12 years of either gender undergoing tonsillectomy. The patients were divided into two equalgroups designated as A and B each having 82 patients using simple random sampling. Patientsin group A were operated for tonsillectomy by bipolar electrocautry while group B underwenttonsillectomy by cold steel dissection method. All patients in both groups were assessed foroperating time and intra-operative blood loss. Results: Out of 82 cases of Bipolar DissectionGroup 49(60%) patients were male and 33(40%) patients were female. Whereas in 82 casesof Cold Dissection...

Predicting safe tonsillectomy for ambulatory surgery

Auris Nasus Larynx, 2010

Objectives: To assess the safety of tonsillectomy procedure in local setting. Methods: Retrospective review of 267 tonsillectomy patients in Tengku Ampuan Afzan Hospital, Malaysia from January 2006 to December 2007. Results: Only 2.6% had trauma, 1.1% had difficult intubation, 0.7% had anaesthetic complication and none developed bleeding intraoperatively. Post-operatively, both primary and secondary haemorrhage showed prevalence of 1.9% each, 1.1% patients had infection and 0.4% patients had inability of extubation while another 1.9% had other complications. Duration of post-operative hospital stay was only slightly increased with occurrence of intra-operative complications but not with post-operative complications. Significant increase in risk was observed for both primary haemorrhage (OR: 1.05, 95% CI 1.01-1.09 min, P = 0.020) and respiratory complications (OR: 1.08, 95% CI 1.01-1.16 min, P = 0.024) by 4.5% and 8.3%, respectively, with every 1-min increase in length of surgery. Conclusions: The observed low prevalence of complications corresponded with large number of studies denoting safety of tonsillectomy. This may well be increased by appropriately reducing the length of surgery. Although predictors for complications were unable to be determined, it is not advisable for ambulatory tonsillectomy to be performed on OSA patients considering the respiratory complications observed in our setting. #

Haemorrhage Rates After Two Commonly Used Tonsillectomy Methods: a Multicenter Study

Medical Archives

Introduction: Tonsillectomy is a frequently used, low-risk surgical procedure. The post-tonsillectomy haemorrhage occurs rarely, but is a life-threatening complication. Some studies show that the surgical technique affects the haemorrhage rate. Aims: To analyse the post-tonsillectomy haemorrhage rate, and to determine whether the effect of the surgical technique on the haemorrhage rate exists. Methods: We retrospectively reviewed data of all patients who underwent a tonsillectomy in three regional ENT departments in Bosnia and Herzegovina (Tuzla, Zenica and Bihac) between January 1 st 2015 and October 31 st 2016. Disorders which could affect the post-tonsillectomy haemorrhage rate were excluded. Tonsillectomy techniques used in these three centers were the hot technique (monopolar/bipolar forceps dissection and haemostasis) and the combined technique (cold steel dissection with monopolar/bipolar forceps haemostasis). Results: 1087 patients that underwent a tonsillectomy were analysed in this study. 864 (79.48%) of those were children. 922 (84.82%) patients were operated using the combined technique, 165 (15.17%) underwent a tonsillectomy using the hot technique. Post-tonsillectomy haemorrhage occured in 46 (4.23%) patients. 45 (4.88%) patients had a postoperative haemorrhage after tonsillectomy using the combined technique, whereas haemorrhage occured in 1 patient (0.6%) after using the hot technique. The haemorrhage rate was about eight times lower after tonsillectomy using the hot technique (p=0.012). Conclusion: We conclude that the surgical technique used for tonsillectomy and adenotonsillectomy with the lowest post-tonsillectomy haemorrhage rate is the hot technique; these results are statistically significant. This technique should be used whenever possible, in order to lower the risk of post-tonsillectomy haemorrhage.

Comparative study of adult tonsillectomy in two methods: harmonic scalpel and classical surgery

The Egyptian Journal of Otolaryngology

Background Tonsillectomy is a common surgery to treat tonsillitis. In addition to cold dissection methods, other new methods are also used for tonsillectomy which has several advantages. We compared the cold dissection methods and the harmonic scalpel method and investigated the complications of both methods. Methods This is a descriptive analytical study on 50 patients in the population of 18 to 60 years who had tonsillectomy conditions based on the inclusion criteria. These patients were divided into two groups, harmonic scalpel method and cold dissection methods, and the duration of the operation, the amount of bleeding during the operation, the pain on the first, fourth, and seventh days after the operation, and the bleeding after the operation were measured in them. Results In this study, 36 men and 14 women were examined. The duration of surgery and the amount of bleeding during surgery were significantly less in the harmonic scalpel method group than in the cold dissection me...