Revisit rates and diagnoses following pediatric tonsillectomy in a large multistate population. Laryngoscope 2015 Feb;125(2):457-61
Date
06/19/2014Pubmed ID
24939092DOI
10.1002/lary.24783Scopus ID
2-s2.0-84921761904 (requires institutional sign-in at Scopus site) 78 CitationsAbstract
OBJECTIVES/HYPOTHESIS: Investigate the incidence and characteristics of revisits following ambulatory pediatric tonsillectomy/adenotonsillectomy.
STUDY DESIGN: Cross-sectional study using national databases.
METHODS: Ambulatory pediatric (age <18.0 years) tonsillectomy or adenotonsillectomy cases were extracted from the 2010 State Ambulatory Surgery, Emergency Department, and Inpatient databases for New York, Florida, Iowa, and California. First and second revisits within the 14-day postoperative period were tabulated. Diagnoses, procedure codes, and mortality were examined.
RESULTS: There were 36,221 pediatric tonsillectomies/adenotonsillectomies (mean age 7.4 years, 51.4% male). Overall, 2,740 patients (7.6%) had a revisit after pediatric tonsillectomy; 402 patients (1.1%) had a second revisit. Among revisits, 6.3% revisited the ambulatory surgery center, 77.5% revisited the emergency department, and 16.2% were readmitted as an inpatient. Among all tonsillectomies, bleeding occurred in 2.0% and 0.5% within the first and second revisits, respectively. A second revisit had a statistically higher association with a primary bleeding diagnosis than the first revisit (P < .001). Among all cases, 0.75% underwent a surgical procedure for bleeding at a first revisit compared to 0.25% during a second revisit. Acute pain was the primary diagnosis in 18.4% and 11.2% of first and second revisits; fever/vomiting/dehydration were primary diagnoses in 28.2% and 17.9%, respectively. There were two mortalities (0.0055%) within the 14-day postoperative interval.
CONCLUSIONS: This large-scale analysis describes the current rates and diagnoses of revisits, hospital readmission, and surgical intervention following ambulatory pediatric tonsillectomy. Many revisits centered on pain control and dehydration, suggesting that more adequate symptom control may prevent a large proportion of revisits.
LEVEL OF EVIDENCE: 2b.
Author List
Shay S, Shapiro NL, Bhattacharyya NAuthor
Sophie G. Shay MD Assistant Professor in the Otolaryngology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdolescentAmbulatory Surgical Procedures
Child
Cross-Sectional Studies
Emergency Service, Hospital
Female
Humans
Incidence
Male
Patient Readmission
Postoperative Complications
Tonsillectomy
United States
