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A Journal on Otorhinolaryngology, Head and Neck Surgery,
Plastic Reconstructive Surgery, Otoneurosurgery

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Otorinolaringologia 2000 June;50(2):89-94

language: English

Day surgery: indications and limits of adenotonsillectomy in children

Tarantino V., Melagrana A., Vallarino R. *, Taborelli G.

From the Department of Otolaryngology and *Department of Anesthesiology and Intensive Care Istituto G. Gaslini, Genova


Background. The ­authors car­ried out an accu­rate inves­ti­ga­tion in ­order to eval­u­ate the eli­gibil­ity of pedi­at­ric ­patients for day sur­gery ade­noi­dec­to­my and/or ton­sil­lec­to­my.
Methods. An accu­rate inves­ti­ga­tion of clin­i­cal and ­social fea­tures as ­well as of post­op­er­a­tive com­pli­ca­tions in 1000 chil­dren under­go­ing ­these sur­gi­cal pro­ce­dures in the Department of Otolaryngology of G. Gaslini Institute in 1998 has ­been per­formed.
Results. The ­major post­op­er­a­tive com­pli­ca­tion was bleed­ing (3.8%), occur­ring ­most fre­quent­ly in the ­first 4 ­hours or ­after day 6 ­from sur­gery (3.5%). Repeated bleed­ing (7.6%) ­showed two ­peaks of inci­dence, i.e. 2.3% in the ­first 4 ­hours and 2.5% ­between the 10th and 13th ­week ­from sur­gery. The over­all inci­dence of com­pli­ca­tions requir­ing med­i­cal treat­ment (1st and 2nd ­degree bleed­ing, hyper­em­e­sis) was not sig­nif­i­cant ­after 14 ­hours (< 0.5%). 17.9% of ­patients ­were not eli­gible for day sur­gery ­because of med­i­cal con­tra­in­di­ca­tions, and 63.1% ­because of ­social fac­tors, main­ly includ­ing ­parents’ inabil­ity to ­give ­home ­care (31.5%). Day sur­gery result­ed hypo­thet­i­cal­ly fea­sible ­only in 31.2% of ­patients.
Conclusions. This ­study ­shows ­that admis­sion typol­o­gy ­should be cho­sen tak­ing ­into ­account not ­only the ­risks relat­ed to the sur­gi­cal pro­ce­dure but ­also ­some soci­omed­i­cal fac­tors. Adenoidectomy and/or ton­sil­lec­to­my are incor­rect­ly con­sid­ered not ­risky and, ­when some­thing ­goes ­wrong, ­this ­false pre­sump­tion gen­er­ates a hos­tile atti­tude in the pub­lic opin­ion, espe­cial­ly if the ­patient is a ­child. Medico-­legal con­flicts, ­that are ­very com­mon in ­these cas­es, are ­stressed by the exis­tence of dif­fer­ent opin­ions on the ­most ade­quate ­type of admis­sion, ­that can ­range ­from day sur­gery ­with ­only 4 ­hours’ obser­va­tion to 7 ­days’ hos­pi­tal­iza­tion, as day sur­gery ton­sil­lec­to­my is con­sid­ered “a use­less ­risk for the ­patient”, and to day sur­gery per­formed ­only ­after 12 ­years of age. The otol­a­ryn­gol­o­gist sci­en­tif­ic com­mu­nity ­should pro­vide com­mon guide­lines in ­order to ­reduce the ­risks for ­both the ­patient and the sur­geon in ­these ­very fre­quent sur­gi­cal pro­ce­dures.

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