TRIO Best Practice articles are brief, structured reviews designed to provide the busy clinician with a handy outline and reference for day-to-day clinical decision making. The ENTtoday summaries below include the Background and Best Practice sections of the original article. To view the complete Laryngoscope articles free of charge, visit Laryngoscope.com.
Background
Ambulatory surgery has become increasingly common in otolaryngology. Cost savings, minimized exposure to hospital-acquired infections, decreased disruption to patient and family routine, and allowing children to recover in more familiar settings are some potential advantages. However, concerns about safety, postoperative symptom management, and parental satisfaction have led many practitioners to routinely admit patients for overnight observation following otologic surgery in the pediatric population.
This article aimed to address whether pediatric otologic surgery, and cochlear implantation in particular, should be performed as an outpatient versus a 23-hour observation procedure.
Best Practice
Tympanomastoid surgery can be safely performed as an outpatient procedure in the pediatric population. However, overnight observation should be made available in cases where intravenous pain medication is required or significant postoperative nausea occurs in the recovery unit. Adequate preoperative counseling is essential to ensuring parental comfort with postoperative care. For example, PONV the first night after cochlear implantation, particularly in very young children, can be frightening for parents because of the concern it represents an early sign of meningitis. Depending upon surgeon and parent preferences, overnight observation can be helpful in the care of these patients (Laryngoscope. 2015;125:1041–1042).