Using Clinical Indicators to Reduce Perianesthesia Recovery Time Following Outpatient Tonsillectomy

Zalzal, Habib G.; Makary, Chadi A.; Evans, Raquel; Giardina, Stacy; Underwood, Tracy; Rowlands, Aletha; Ramadan, Hassan H.

doi:10.1177/0003489418783226

Cited by 5 publications

(3 citation statements)

References 9 publications

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“…Domestic standards for outpatient tonsillectomy postoperative monitoring vary significantly. Published studies from the United States recommend anywhere from 2 to 6 hours 5,39-41 of postoperative observation. Our children’s hospital utilizes a standardized PACU monitoring time of 4 hours, with the goal of capturing postoperative adverse events, namely respiratory and bleeding episodes.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Occurrence and Timing of Post-Tonsillectomy Hemorrhage: A Case-Control Study

Gross

Lindburg

Kallogjeri

et al. 2020

Ann Otol Rhinol Laryngol

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Objective: To describe cases and timing of pediatric post-tonsillectomy hemorrhage (PTH), to evaluate predictors of PTH, and to determine the optimal amount of postoperative care unit (PACU) monitoring time. Study Design: Using the Pediatric Health Information System (PHIS) database and electronic medical records, a matched case-control study from 2005 to 2015 was performed. Setting: A single, tertiary-care institution. Subjects and Methods: Each case of PTH was matched with 1 to 4 controls for the following factors: age, sex, surgeon, and time of year. A total of 124 cases of PTH and 479 tonsillectomy controls were included. The rate and timing of postoperative bleeding were assessed, and matched pair analysis was performed using conditional logistic regression. Results: Our institutional PTH rate of 1.9% (130 of 6949) included 124 patients; 15% (19) were primary (≤24 hours), with 50% (9) occurring within 5 hours. Twenty-one percent (4 of 19) of primary PTH patients received operative intervention. Eighty-five percent (105 of 124) of all cases were secondary PTH, and 47% (49) of those patients received operative intervention. Cold steel (OR 1.9, 95% CI 1.1-3.3) and Coblation (OR 1.9, 95% CI 1.2-3.1) techniques and tonsillectomy alone (OR 3.7, 95% CI 1.9-7.2) increased odds of PTH. Patients who developed PTH had 4 times the odds of having a preceding postoperative respiratory event than controls (OR 4.0, 95% CI 1.6-10.0). Conclusion: We conducted a rigorous case-control study for PTH, finding that PTH was associated with use of cold steel and Coblation techniques and with tonsillectomy alone. Patients with a postoperative respiratory event may be more likely to develop a PTH and should be counseled accordingly. A PACU monitoring time of 4 hours is sufficient for outpatient tonsillectomy.

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Section: Discussionmentioning

confidence: 99%

Predictors of Occurrence and Timing of Post-Tonsillectomy Hemorrhage: A Case-Control Study

Gross

Lindburg

Kallogjeri

et al. 2020

Ann Otol Rhinol Laryngol

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“…Die Überwachung erfolgt durch Fachpersonal in einem Aufwachraum wie unter stationären Bedingungen für mindestens 2 h. Es sind Eingriffe/Narkosen zu definieren, bei denen in jedem Fall eine Aufwachraumzeit von mindestens 4 h erforderlich ist [30]. Nach ei-ner eingriffsindividuellen Checkliste kann der Patient aus dem Aufwachraum mit fortlaufendem Monitoring entlassen werden.…”

Section: Postoperative Phaseunclassified

Ambulantes Operieren in der HNO-Heilkunde in Deutschland

Deitmer¹,

Dietz

Delank

et al. 2021

Laryngorhinootologie

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ZusammenfassungEs ist gesundheitspolitischer Wille, die ambulante Chirurgie in der HNO-Heilkunde in Deutschland auszuweiten und in einem Umfang auszuüben, wie es im internationalen Bereich wahrgenommen wird.Um die Voraussetzungen für eine sinnvolle Umsetzung dieses Ansatzes zu bestimmen und für Patienten und Ärzte einen akzeptablen und sicheren Rahmen bei gleichbleibender Qualität im Vergleich zu stationären Verfahren erreichen zu können, wird ein Review der internationalen Literatur zu Organisation, Ergebnissen und Durchführung solcher ambulanten Eingriffe in der HNO-Heilkunde durchgeführt.Ambulantes Operieren findet international in verschiedenen Strukturen und Organisationsformen statt. So erfolgen z. B. kleinere Operationen ohne Vollnarkose in Praxen (office based surgery), größere Operationen in ambulanten Operationszentren, die solitär oder an Kliniken angelehnt sein können und in denen Verweildauern von wenigen Stunden (day case surgery) bis hin zu 23 Stunden (23 h case surgery) praktiziert werden. Eine sorgfältige Selektion der Patienten für die ambulante Chirurgie wird mit Blick auf Komorbiditäten, Medikationen, soziale und häusliche Betreuungsmöglichkeiten sowie Wegestrecken und -zeiten betrieben. Ein striktes Qualitätsmanagement der gesamten Abläufe wird unter Einbezug aller Berufsgruppen gefordert.

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“…Tonsillectomy and adenotonsillectomy are two common surgeries in the ENT (ear, nose, and throat) (1), in which postoperative pain as the major complication occurs during swallowing due to the stimulation of nerve endings in the tonsil bed, throat muscle spasm, and postingestion inflammation (2). These surgeries are mostly performed on pediatric age group who are more susceptible to postoperative pain and complications of typical methods of pain management than adults (3).…”

Section: Introductionmentioning

confidence: 99%

The Effect of Gargling Cold Normal Saline in Comparison to Normal Saline Mixed with Honey on Postoperative Pain Relief in Tonsillectomy or Adenotonsillectomy: A Randomized Clinical Trial

Raoufian¹,

Nasiri²,

Ghafari³

et al. 2020

Iran Red Crescent Med J

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Objectives: The present study was conducted to compare the effect of gargling normal saline mixed with honey and cold normal saline on postoperative pain relief in children undergoing tonsillectomy or adenotonsillectomy during 2018. Methods: This clinical trial was performed on 105 children aged 5-14 years. The participants were randomly allocated to three 35-member groups, viz. normal saline mixed with honey, cold normal saline, and the control. The patients underwent general anesthesia and then were operated by a single surgeon. Gargle was administered in the first and second groups every six hours up to 48 hours following the surgery. There was no intervention in the control group. The pain was recorded by the Wong-Baker FACES Pain Rating Scale (WBS) at the recovery time and 6, 12, 18, 24, 36, 48 hours and 7 days after the surgery. Data were analyzed using repeated measures ANOVA. Results: Among the participants, 47 subjects (44.8%) were males and the rest were females, with a mean age of 8.6 ± 2.5 years. The three groups were similar in terms of sex, weight, duration of surgery, and bleeding during surgery. The pain at the site of surgery during both resting and swallowing was different at 6, 12, 18, 24, 36, 48 hours, and 7 days following the surgery (P < 0.001). Conclusions: Gargling cold normal saline and normal saline mixed with honey led to reduced pain after tonsillectomy or adenotonsillectomy; however, the latter had a higher effect on the postoperative pain relief.

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Using Clinical Indicators to Reduce Perianesthesia Recovery Time Following Outpatient Tonsillectomy

Abstract: This study demonstrates that using clinical indicators as discharge criteria is both safe and efficient, with a low rate of postoperative complications.

Cited by 5 publications

References 9 publications

Predictors of Occurrence and Timing of Post-Tonsillectomy Hemorrhage: A Case-Control Study

Predictors of Occurrence and Timing of Post-Tonsillectomy Hemorrhage: A Case-Control Study

Ambulantes Operieren in der HNO-Heilkunde in Deutschland

The Effect of Gargling Cold Normal Saline in Comparison to Normal Saline Mixed with Honey on Postoperative Pain Relief in Tonsillectomy or Adenotonsillectomy: A Randomized Clinical Trial

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