Revisit Diagnoses, Rates Similar for Ambulatory and Children’s Hospital Tonsillectomies

How frequent are revisits following ambulatory pediatric tonsillectomy/adenotonsillectomy, and what are their characteristics?

Background: Between 1996 and 2006, the rate of pediatric tonsillectomies nearly doubled, with adenotonsillectomies comprising 16% of ambulatory surgeries within the pediatric population. There has also been a significant shift toward performing these procedures in an ambulatory setting. The most common significant post-operative morbidities are hemorrhage and respiratory complications, with an increased risk in OSA patients. Considerable variation exists in peri-operative and post-operative management of adenotonsillectomies.

Study design: Cross-sectional study using national databases of 36,221 ambulatory pediatric tonsillectomies/adenotonsillectomies during 2010.

Setting: State Ambulatory Surgery, Emergency Department, and Inpatient databases for New York, Florida, Iowa, and California.

Synopsis: The current study focused on the 14-day post-operative period. Overall, 2,740 patients (7.6%) had a revisit after pediatric tonsillectomy. Among these, 6.3% revisited the ambulatory surgery center, 77.5% revisited the emergency department, and 16.2% were readmitted as an inpatient. Overall, 402 patients (1.1%) had a second revisit, with 16.4% of these revisiting the ambulatory surgery center, 70.9% revisiting the emergency room, and 12.7% admitted as an inpatient. The primary revisit diagnoses were determined as post–tonsillectomy bleeding, acute pain, or fever/nausea/vomiting/dehydration. Among all patients undergoing tonsillectomy, 2.0% of patients had a post-tonsillectomy bleeding diagnosis at a first revisit, and 0.5% of patients had the diagnosis as part of their second revisit. A second revisit was statistically more likely to be associated with a primary bleeding diagnosis than the first revisit. Post-operative pain issues and fever/vomiting/dehydration were found to be the primary reasons for post-tonsillectomy revisits.

Bottom line: This large-scale, multistate analysis demonstrated an overall revisit rate of 7.6% following ambulatory pediatric tonsillectomy, consistent with other reports for freestanding children’s hospitals. Many revisits centered on pain control and dehydration, suggesting that more adequate symptom control may prevent a large proportion of revisits.

Citation: Shay S, Shapiro NL, Bhattacharyya N. Revisit rates and diagnoses following pediatric tonsillectomy in a large multistate population. Laryngoscope. 2015;125:457-461.

—Reviewed by Amy Hamaker