Improving safety for day case adenotonsillectomy in paediatric obstructive sleep apnoea

Abstract

Paediatric obstructive sleep apnoea (OSA) is characterised by stertor, intermittent oxygen desaturation and repeated nocturnal awakening. 1 If left untreated, it can have significant repercussions, such as cor pulmonale, growth and developmental delay. 2 Adenotonsillectomy has proven to be effective in improving OSA outcomes in the majority of children. 3 Tonsillectomy (with or without adenoidectomy) is the most frequent ENT procedure comprising of 17% of the workload in the UK. 4 There has been an effort in recent years to improve day case surgery rates for these patients and to ensure safe delivery of services at secondary and tertiary centres within the UK for children with OSA. 5 Improvements in patient care will therefore have a widereaching impact on children and their families. Knowledge of post-operative complication rates for childrenwith OSA undergoing adenotonsillectomy is essential to be able to deliver safe and appropriate care and to support informed consent and shared decision-making. Age and comorbidities have been investigated to varying degrees to determine whether day case surgery and surgical delivery in secondary care centres are safe. [6][7][8] Since 2015, our paediatric tertiary centre has undergone a 3-stage service improvement process aimed at improving the safety of day case adenotonsillectomy for paediatric patients with OSA. We present our data and outcomes from our tertiary centre experience which has been used to help create the national strategy, released in 2019, for managing paediatric patients with OSA undergoing adenotonsillectomy.

Day‐case discharge criteria and safety of children undergoing adenoidectomy and tonsillectomy for obstructive symptoms—A systematic review

“…2,4,[8][9][10][11][12][13][14][15][16][17][18][19][20] See Figure 1 for a PRISMA flow diagram illustrating the study selection process. 2,4,[8][9][10][11][12][13][14][15][16][17][18][19][20] All included studies were observational: 14 retrospective and one prospective. 12 One study had a control group for outcome comparison.…”

“…Five studies did not report on how OSA was diagnosed in their population. 9,13,14,17,18 Three studies diagnosed OSA by using typical clinical symptoms, 10,19,20 and in another three studies the clinical diagnosis was confirmed by sleep studies or polysomnography (PSG) in some of the patients. 8,12,15 Four studies only included PSG-confirmed cases.…”

“…Seven studies reported their day-case discharge criteria in children with OSA following surgery 8,9,15,[17][18][19][20] (Table 1). No standardised day-case discharge criteria was used across studies, however, common themes were: age over 2 years, mild-to-moderate OSA, no significant comorbidities, living with a reliable caregiver in close proximity to the hospital and absence of post-operative complications in the first few hours of observation.…”

“…showing the process of inclusion and exclusion children). 2,8,9,[13][14][15]17,19,20 Of these, seven studies commented on the proportion planned day-case surgeries that were successful, which ranged from 92.9% to 100% (n = 2446). 2,8,9,13,15,19,20 The overall proportion of successful day-case surgeries in the planned day-case groups was 96.1%.…”

“…Five studies reported on readmissions. 2,14,15,19,20 Chorney et al 14 specified that readmission data including A&E attendance was collected for a 30-day period following the operation. Reasons for readmission, and timings of readmissions were not clearly stated in this study.…”