Pediatric adenoidectomy in the very young child and indications for postoperative inpatient admission

Chorney, Stephen R.; Dailey, Julia; Zur, Karen B.

doi:10.1016/j.ijporl.2019.109796

Cited by 11 publications

(20 citation statements)

References 28 publications

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“…Patient age is one of the factors for bleeding, but the data are not conclusive. While some studies confirm that age is not a risk factor for bleeding [2], other authors have shown that the bleeding is very rare in children under 3 years [24] and that older age is associated with a greater risk of bleeding and need for revision in the operating room [1]. In our study, we did not show an effect of age on bleeding.…”

Section: Discussioncontrasting

confidence: 87%

Risk Factors for Postoperative Bleeding after Adenoidectomy

et al. 2021

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IMPORTANCE: Postoperative bleeding is a common and potentially life-threatening complication. Precise identification of risk factors in addition to the basic ones, such as coagulation parameters, is certainly very desirable. OBJECTIVE: The aim of this study was to identify other possible risk factors for bleeding after adenoidectomy in children. DESIGN: This observational prospective study enrolled children undergoing adenoidectomy from October 2019 to February 2020, then evaluated the influence of possible risk factors for bleeding. SETTING: Tertiary pediatric otorhinolaryngology center. PARTICIPANTS: A total of 288 children aged 0–18 years undergoing adenoidectomy for recurrent upper respiratory tract infections, recurrent acute otitis media, secretory otitis media, and obstructive sleep apnea syndrome. MAIN OUTCOMES AND MEASURES: Increased blood pressure and time of surgery were identified as risk factors for bleeding after adenoidectomy. RESULTS: Elevated systolic (p = 0.046), diastolic (p = 0.012), and mean arterial blood pressure (p = 0.007) (Mann–Whitney U test) as adjusted for age-specific distributions and with corrections for height and weight, as well as time length of surgery (p < 0.001) (Fisher’s exact test) were revealed as statistically significant risk factors for postoperative bleeding. Atmospheric pressure, surgeon’s level of experiences, chronic inflammatory content in adenoid vegetation (AV), size of AV, recidivism of AV, recurrent infections of the upper respiratory tract, type of anesthesia, long-term using of drugs, and positive coagulation questionnaire or pathology in standard coagulation tests were not found to be risk factors for bleeding after adenoidectomy. CONCLUSIONS AND RELEVANCE: In this prospective study within a well-defined population of children, we evaluated increased blood pressure and time of surgery as risk factors for bleeding after adenoidectomy. These data bring new information that complements current knowledge in this field.

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Section: Discussioncontrasting

confidence: 87%

Risk Factors for Postoperative Bleeding after Adenoidectomy

et al. 2021

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“…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.…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Ascertainment Of Osamentioning

confidence: 99%

“…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%.…”

Section: Criteria For Same-day Dischargementioning

confidence: 99%

“…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.…”

Section: Criteria For Same-day Dischargementioning

confidence: 99%

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

Gowda

Leong

Edafe

2022

Clinical Otolaryngology

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Objectives Obstructive sleep apnoea (OSA) is a common indication for adenoidectomy and tonsillectomy in children. Traditional practice involves overnight admission to monitor for respiratory complications. However, there is a shift towards same‐day discharge in selected patients. This systematic review aims to critically evaluate day‐case criteria and safety in children with OSA undergoing adenotonsillectomy. Design We performed a systematic search of EMBASE, Medline and the Cochrane library. All data collected were independently validated for accuracy. Quality assessment of included articles was performed. The protocol was registered with PROSPERO. Results A total of 15 studies were included (10 731 patients). There was heterogeneity in methods used to ascertain OSA, day‐case discharge criteria and lack of prospective discharge protocol. The proportion of children considered for planned day‐case surgery ranged from 28.7%–100% based on individual criteria, with an average rate of successful same‐day discharge of 96.1% in these patients. The reported rates of post‐operative respiratory adverse events and need for airway intervention were 0%–27.3% and 0.4%–6.8%, respectively. There was no reported mortality. The studies were considered low to medium on quality assessment. Conclusion There is a lack of prospective data on day‐case criteria and systematic assessment of post‐operative complications in children with OSA undergoing adenoidectomy and tonsillectomy. However, current literature suggests that day‐case surgery is safe in carefully selected patients. Better characterisation of patient‐specific risk factors is needed to develop an optimal criteria‐based timeline for safe discharge. This has the potential to improve confidence and uptake across units.

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Estimated Probability Distribution of Bleeding After Pediatric Tonsillectomy

Johnson

Beams

Zaniletti

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportanceThe American Academy of Otolaryngology–Head and Neck Surgery Foundation has recommended yearly surgeon self-monitoring of posttonsillectomy bleeding rates. However, the predicted distribution of rates to guide this monitoring remain unexplored.ObjectiveTo use a national cohort of children to estimate the probability of bleeding after pediatric tonsillectomy to guide surgeons in self-monitoring of this event.Design, Settings, and ParticipantsThis retrospective cohort study used data from the Pediatric Health Information System for all pediatric (&lt;18 years old) patients who underwent tonsillectomy with or without adenoidectomy in a children’s hospital in the US from January 1, 2016, through August 31, 2021, and were discharged home. Predicted probabilities of return visits for bleeding within 30 days were calculated to estimate quantiles for bleeding rates. A secondary analysis included logistic regression of bleeding risk by demographic characteristics and associated conditions. Data analyses were conducted from August 7, 2022 to January 28, 2023.Main Outcomes and MeasuresRevisits to the emergency department or hospital (inpatient/observation) for bleeding (primary/secondary diagnosis) within 30 days after index discharge after tonsillectomy.ResultsOf the 96 415 children (mean [SD] age, 5.3 [3.9] years; 41 284 [42.8%] female; 46 954 [48.7%] non-Hispanic White individuals) who had undergone tonsillectomy, 2100 (2.18%) returned to the emergency department or hospital with postoperative bleeding. The predicted 5th, 50th, and 95th quantiles for bleeding were 1.17%, 1.97%, and 4.75%, respectively. Variables associated with bleeding after tonsillectomy were Hispanic ethnicity (OR, 1.19; 99% CI, 1.01-1.40), very high residential Opportunity Index (OR, 1.28; 99% CI, 1.05-1.56), gastrointestinal disease (OR, 1.33; 99% CI, 1.01-1.77), obstructive sleep apnea (OR, 0.85; 99% CI, 0.75-0.96), obesity (OR,1.24; 99% CI, 1.04-1.48), and being more than 12 years old (OR, 2.48; 99% CI, 2.12-2.91). The adjusted 99th percentile for bleeding after tonsillectomy was approximately 6.39%.Conclusions and RelevanceThis retrospective national cohort study predicted 50th and 95th percentiles for posttonsillectomy bleeding of 1.97% and 4.75%. This probability model may be a useful tool for future quality initiatives and surgeons who are self-monitoring bleeding rates after pediatric tonsillectomy.

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Pediatric adenoidectomy in the very young child and indications for postoperative inpatient admission

Cited by 11 publications

References 28 publications

Risk Factors for Postoperative Bleeding after Adenoidectomy

Risk Factors for Postoperative Bleeding after Adenoidectomy

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

Estimated Probability Distribution of Bleeding After Pediatric Tonsillectomy

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