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A Journal on Otorhinolaryngology, Head and Neck Surgery,
Plastic Reconstructive Surgery, Otoneurosurgery
Indexed/Abstracted in: EMBASE, Scopus
Otorinolaringologia 2000 June;50(2):89-94
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.