What is the effect of postoperative steroids on postoperative physician contacts and the hemorrhage rate for pediatric tonsillectomy patients?
Bottom line
A short course of postoperative steroids decreased postoperative tonsillectomy hemorrhage risk by 7% and the number of postoperative phone calls for pain by 9% after tonsillectomy in pediatric patients.
Background: During the last 50 years postoperative tonsillectomy care has remained relatively unchanged, with a primary emphasis on avoiding postoperative hemorrhage and controlling pain. There is a significant opportunity to optimize outcomes and reduce complications by maximizing safe pain control in a way that limits readmission or the need for clarifying phone calls to the physician’s office after surgery.
Study design: Retrospective review of medical records of 1,200 children undergoing tonsillectomies between 2011 and 2015 before and after the institution of a standard postoperative course of three doses of dexamethasone.
Setting: Cincinnati Children’s Hospital Medical Center.
Synopsis: Patients were placed in one of four groups: Group 1 (tonsillectomy in 2011 and 2012 by surgeons A/B, who routinely gave postoperative oral steroids); Group 2 (tonsillectomy between 2011 and 2012 by surgeons C/D/E/F who did not give routine postoperative steroids); Group 3 ( “control” group; tonsillectomy between 2013 and 2014 by surgeons A/B, who routinely gave postoperative oral steroids); and Group 4 (tonsillectomy between 2013 and 2014 by surgeons C/D/E/F who did give postoperative oral steroids). Analysis among the groups with children receiving steroids (1, 3, and 4) and the group not receiving steroids (2) shows a significant decrease in phone calls for pain (14.7% from 23.3%) and post-tonsillectomy hemorrhage rate (5.7% from 9.7%) in the steroid group. The likelihood of post-tonsillectomy hemorrhage or a phone call for pain increased with increasing patient age; however, steroids decreased hemorrhage risk by 7% and the risk of a phone call for pain by 9%. Limitations included the heterogenous nature of perioperative anesthesia protocols, and a lack of knowledge regarding compliance with the prescribed postoperative steroids.
Citation: Redmann AJ. Maksimoski M, Brumbaugh C, Ishman SL. The effect of postoperative steroids on post-tonsillectomy pain and need for postoperative physician contact. Laryngoscope. March 24, 2018. doi: 10.1002/lary.27167.