PubMed · 6556642
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A Nicol. 1983-10-19. Nursing care study: tonsillectomy.. https://pubmed.ncbi.nlm.nih.gov/6556642/
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OBJECTIVE: To determine the risk of complications after discharge in outpatient adenotonsillectomy after a short (< 6 hours) period of postoperative observation. DESIGN: Retrospective chart review. SETTING: Outpatient surgery center at a university hospital. PATIENTS: All patients 18 years of age or less who were scheduled for adenotonsillectomy or tonsillectomy from January 1988 through December 1991. Two hundred fifty-five patient records were reviewed. Twenty-two patients were excluded from the study because of various complicating medical conditions that required planned overnight hospitalization leaving a study population of 233 patients. MAIN OUTCOME MEASURES: (1) Rate and type of complications; (2) duration of postoperative observation. RESULTS: Complication rates of bleeding, emesis, dehydration, and readmission were compared with rates deemed acceptable in the literature (< or = 10%). Power analysis demonstrated that the patient number was sufficient to establish a 95% confidence interval for a complication rate of 0% to 10%. The mean duration of postoperative observation was 136 +/- 48 minutes. Complications included bleeding, emesis, dehydration, and nonscheduled admissions. The total complication rate was 9% (95% confidence interval, 5.5% to 12.7%). The rate of primary bleeding was 1.4%, and all primary bleeding occurred within 75 minutes of arrival in the recovery room; no primary bleeding occurred after discharge from day surgery. This complication rate is comparable with rates previously described in the literature for patients who were observed for a 6- to 12-hour period. CONCLUSION: The findings in this study suggest that short periods of observation are safe for outpatient pediatric patients undergoing adenotonsillectomy after discharge criteria are met.
OBJECTIVES: To determine (1) the prevalence of obstructive sleep apnea (OSA) in children with a suggestive history; (2) the effectiveness of surgery in treating OSA in children; and (3) factors that may help the physician select patients who have physiologically significant OSA and are likely to respond to surgery. DESIGN: Prospective study. PATIENTS: Sixty-nine children aged 1 to 14 years who were referred to the otolaryngologist for evaluation of suspected OSA. INTERVENTIONS: Thirty children with a respiratory disturbance index (RDI) greater than 5 underwent adenotosillectomy. Twenty-six of the 30 children had follow-up polysomnography. MAIN OUTCOME MEASURES: Polysomnography after surgery. RESULTS: Thirty-five (51%) of 69 children had an RDI greater than 5 on polysomnography. Twenty-six of the 30 children who underwent adenotonsillectomy for OSA had follow-up polysomnography. All 26 children had a lower RDI after surgery, although four patients still had an RDI greater than 5. A preoperative RDI of 19.1 or less predicted a postoperative RDI of 5 or less. History and physical findings were not useful in predicting outcome. CONCLUSIONS: All patients improved with adenotonsillectomy, but patients with the most severe RDI often had many respiratory events after surgery. History and physical examination alone are not sufficient to assess the severity of OSA or the likelihood of an adequate response to surgical treatment.
OBJECTIVE: To determine outcomes achieved by treating refractory pediatric rhinosinusitis with a stepped protocol of additional antibiotics, adenoidectomy, and functional endoscopic sinus surgery (FESS). DESIGN: Prospective cohort with follow-up at 2 to 3 months and at 10 to 12 months. SETTING: Hospital-based pediatric otolaryngology practice with community satellite offices. PARTICIPANTS: Consecutive 10-month sample of 41 children aged 2 to 13 years who met the following criteria: (1) roentgenographically documented sinusitis, (2) at least one 3-week course of a beta-lactamase stable antibiotic, (3) 3 months or more of clinical symptoms or three or more annual recurrences, (4) no obstructive adenoid hyperplasia, and (5) no cystic fibrosis. INTERVENTIONS: Fifteen children (37%) received additional antibiotics alone. Nonresponders underwent adenoidectomy (n = 10) when adenoids were present or FESS (n = 16) when adenoids were scant or if adenoidectomy did not provide relief (n = 2). MAIN OUTCOME MEASURES: Unblinded, oral survey of symptomatic response, caregiver expectations, and quality-of-life issues. Responses from the 12 survey questions were combined to produce a sinusitis response score. RESULTS: Caregiver expectations were met in 88% of children 1 year after treatment but were more often exceeded in patients undergoing FESS (50%) compared with those receiving antibiotics with or without adenoidectomy (13%). Functional endoscopic sinus surgery improved all major symptoms in 100% of children compared with 67% of those receiving antibiotics alone and 75% of those receiving antibiotics and undergoing adenoidectomy. In contrast, complete symptom resolution occurred in only 27% of patients, with no significant differences among groups. The median sinusitis response score of 84% was not associated with treatment level but was negatively associated with male gender. CONCLUSIONS: A stepped treatment approach to refractory sinusitis can improve quality of life for children and caregivers. Additional antibiotic therapy and adenoidectomy should be considered before FESS, even if the adenoids are nonobstructing.