Tonsillectomy Cases Research Articles

Post-Operative Bleeding in Tonsillectomy versus Tonsillectomy with Fossa Closure in a Tertiary Military Hospital: A Cohort Study

ABSTRACT
 Objective: To determine the incidence of post-operative bleeding among patients who underwent tonsillectomy alone versus tonsillectomy with fossa closure at the Victoriano Luna Medical Center from January 2015 to December 2017.
 Methods: 
 Design: Retrospective Cohort Study
 Setting: Tertiary Military Hospital
 Patients: Medical records of 83 patients that underwent tonsillectomy under the Department of Otorhinolaryngology – Head and Neck Surgery between January 2015 to December 2017 were retrospectively reviewed for data regarding sex, age, tonsillectomy with or without fossa closure and post-operative bleeding. Cases of tonsillectomy alone versus tonsillectomy with fossa closure were compared (particularly with respect to post-operative bleeding), tabulated and statistically analyzed using risk ratio and t-test.
 Results: There were 57 cases of tonsillectomy alone versus 26 cases of tonsillectomy with fossa closure. The incidence of bleeding in all cases of tonsillectomy whether tonsillectomy alone or with fossa closure was 4.8%. The incidence of bleeding was higher in cases of tonsillectomy with fossa closure at 11.5% (versus 1.8% in tonsillectomy alone). Post-operative bleeding was 0.1 times more likely to occur in patients who underwent tonsillectomy alone than those who underwent tonsillectomy with fossa closure but there was no statistically significant difference in the risk of post-operative bleeding between the two.
 Conclusion: Although the incidence of bleeding was higher in cases of tonsillectomy with fossa closure, our results suggest that there is no statistically significant difference in risk for postoperative bleeding between tonsillectomy alone or tonsillectomy with fossa closure.
 Keywords: tonsillectomy; postoperative bleeding; tonsil pillars; suturing

Prevalence of Post-Tonsillectomy Hemorrhage in Adults and Children

Background and objectivesHemorrhage is the most common complication of tonsillectomy. However, the incidence of post-tonsillectomy hemorrhage may be affected by various factors including weight, age, medications, surgical technique, etc. This study was carried out to determine prevalence of post-tonsillectomy hemorrhage in patients undergoing tonsillectomy in a teaching hospital in Gorgan, Iran.MethodsThis descriptive study was conducted on 1,043 cases of tonsillectomy who were admitted to a referral teaching hospital in Gorgan (Iran) between 2016 and 2017. Data were collected from medical records. Demographics characteristics, the applied surgical technique (e.g., tonsillectomy, adenoidectomy and adenotonsillectomy), the time of bleeding onset, the results of coagulation tests and the method of post-tonsillectomy hemorrhage management were recorded.ResultsThe frequency of tonsillectomy was 19.2, 50.8, 18.6, 4, 2.1 and 5.3% in subjects aged 0-5, 5-10, 10-15, 15-20, 20-25 and more than 25 year old, respectively. The overall prevalence of post-tonsillectomy hemorrhage was 2.1%. The frequency of post-tonsillectomy hemorrhage was highest (13.6%) in patients aged 20-25 years. The incidence of post-tonsillectomy hemorrhage was zero in those aged ≤5 years. The rate of post-tonsillectomy hemorrhage was 54.5, 31.8 and 13.6% for those undergoing tonsillectomy, adenoidectomy and adenotonsillectomy, respectively. Secondary post-tonsillectomy hemorrhage (after 24 hours) was more common (81.8%). Moreover, the rate of re-admission for controlling the bleeding was 63.4% (14 cases).ConclusionThe incidence of post-tonsillectomy hemorrhage, the methods for its management and the need for re-admission are quite different in different age groups.

A Clinical Review of Tonsillectomy Cases from 1955 to 2016

当院での1955～2016年まで (62年間) の口蓋扁桃摘出術 (扁摘術) の各年毎の総手術件数に対する割合, 麻酔法, 対象症例の変遷を検討した. 1997～2016年の20年間については, 適応となった疾患の調査を合わせて行った. 62年間の手術総数27,623件のうち, 扁摘術は5,852件と21.2%を占めた. 全手術に対する割合は1960年代に32～58%と高く, その後は15%前後で推移した. 麻酔法は, 初期の局所麻酔から, 1969～1987年に全身麻酔と混在し, 1988年以降は全例が全身麻酔となった. 男性例が52%と多く, 年齢分布では, 1960年代までは小児例が圧倒的で6～10歳にピークの一峰性を示していたが, 1970年代から21～25歳の若年成人にもピークが見られる2峰性となり, その後成人例の方が多くなり, 2010年代からは再び小児例が増加し中高年に至る幅広い年齢層の分布となった. 小児の扁桃肥大と慢性炎症に対して局所麻酔で多くの手術が行われた時代から, 全身麻酔での手術に変わり, 保存的治療の進歩とともに手術適応が厳しく検討されるようになった. 炎症性では程度や頻度の高い例だけが対象となり, 小児睡眠時呼吸障害に対する適応, IgA 腎症など病巣扁桃としての適応が確立されたことが, 年齢分布の変遷に反映されたと思われる. 今なお耳鼻咽喉科手術の中で頻度の高い, 重要な手術である.

A Study on 94 Cases of Tonsillectomy for IgA Nephropathy

A Study on 94 Cases of Tonsillectomy for IgA Nephropathy

Clinical Characteristics, Complications, and Reasons for Readmission following Lingual Tonsillectomy.

This brief communication regards the indications and complications for and rates of readmission following lingual tonsillectomy. The National Readmissions Database (NRD) 2013-2014 was queried for all cases of lingual tonsillectomy occurring from 2013 to 2014. Among 602 lingual tonsillectomies (mean age 36.5 years, 58.2% male), the common indications for surgery were obstructive sleep apnea (58.7%), lingual tonsil hypertrophy/infection (18.8%), and neoplasia (15.9%). Overall, 49 (8.2%) of the cases were readmitted (95% confidence interval, 4.8%-13.5%), with an average readmission duration of 3.0 days and average readmission cost of $25.4K. The most common diagnoses at readmission were bleeding (1.9% of all lingual tonsillectomy cases); dysphagia (1.7%); fever, nausea, vomiting, or diarrhea (1.6%); acute pain (1.6%); and airway obstruction (1.4%). There were no mortalities during primary or subsequent admissions. Lingual tonsillectomy across age groups is relatively free of adverse events, with overall readmission and complication rates similar to those of palatine tonsillectomy.

Gross Pathology of Routine Pediatric Tonsillectomy Specimens: Optimizing the Value of Patient Care.

This investigation seeks to evaluate the effect of gross pathologic analysis on our management of patients undergoing routine tonsillectomy and to evaluate charges and reimbursement. Retrospective chart review from 2005 through 2016. Academic medical center. Participants were pediatric patients aged 14 years and younger undergoing tonsillectomy for either sleep-disordered breathing or tonsillitis, with tonsillectomy specimens evaluated by pathology, and without any risk factors for pediatric malignancy. Records were reviewed for demographics, surgical indications, and pathology. Abnormal reports prompted an in-depth review of the chart. Charges and reimbursement related to both hospital and professional fees for gross tonsil analysis were evaluated. From 2005 to 2016, 3183 routine pediatric tonsillectomy cases were performed with corresponding specimens that were sent for gross analysis revealing no significant pathologic findings; 1841 were males and 1342 were females. Ten cases underwent microscopy by pathologist order, revealing normal tonsillar tissue. The mean charge per patient for gross analysis was $60.67 if tonsils were together as 1 specimen and $77.67 if tonsils were sent as 2 separate specimens; respective reimbursement amounts were $28.74 and $35.90. Gross pathologic analysis did not change our management of routine pediatric tonsillectomy patients. Foregoing the practice at our institution would eliminate $19,171.72 to $24,543.72 in charges and $9081.40 to $11,344.40 in reimbursement per year. Eliminating this test would improve the value of patient care by saving health care resources without compromising clinical outcomes.

Voice Analysis in Post Tonsillectomy Patients.

The main aim of this study was to analyse the change in voice in terms of acoustic parameters and its perceptual impact in patients who have undergone tonsillectomy. A prospective study was conducted in our institution-JSS Hospital and JSS institute of speech and hearing, Mysore for a duration of 1year (December 2015-December 2016). 50 post tonsillectomy cases were selected randomly and subjected to acoustic analysis. It was inferred that situation of vocal analysis and assessment for the vowels 'a', 'i' and 'u' under the categories hoarse, harsh and breathy remain more or less the same during preoperative stages, first preoperative follow up and the second post operative follow up. It was concluded that tonsillectomy did not appear to change the acoustic features of vowels remarkably. It was assumed that the subject may adjust the shape of the vocal tract to produce consistent speech sound after surgery using auditory feedback.

Role of Intraoperative Topical Application of 0.5% Bupivacaine in Tonsillar Fossa for Postopeartive Analgesia in Tonsillectomy Cases

Role of Intraoperative Topical Application of 0.5% Bupivacaine in Tonsillar Fossa for Postopeartive Analgesia in Tonsillectomy Cases

Secondary tonsillar hemorrhage requiring surgical intervention: Analysis of 1429 tonsillectomy cases on single surgeon experience

Objective: Determination of risk factors affecting secondary tonsillar hemorrhage of the requiring surgical intervention. Material and Method: 1429 tonsillectomy cases performed with three different dissection techniques (dissection and snare, bipolar and monopolar dissection) by a single surgeon were examined retrospectively.  Age, sex, surgical knowledge, indications and postoperative tonsillar hemorrhage day of the patients were recorded. Patients who were operated on for hemorrhage were evaluated statistically in terms of technique used, age, sex and indications. Findings: A total of 25 cases of a secondary hemorrhage cases requiring surgical intervention were detected. The relationship between age and bleeding was statistically significant (p=0.003). Hemorrhage frequency requiring surgical intervention was significantly higher in patients with recurrent tonsillitis than in patients with tonsillar hypertrophy (p = 0.001). 19 of the 25 patients who were operated on for hemorrhage were in the group of tonsillectomy patients due to recurrent tonsillitis. There was no meaningful relationship in terms of sex. The hemorrhage rate in the dissection and snare technique was 1.74% (12 patients), the hemorrhage rate in bipolar dissection was 2.78% (9 patients), and the monopolar dissection- hemorrhage rate was 0.96% (4 patients). There was no statistically significant difference between the results (p = 0.170). It was determined that the hemorrhage required surgery at most was between 6th and 10th days. Conclusion: While there was no significant relationship between the incidence of secondary tonsillar hemorrhage requiring surgery and gender and dissection techniques, it has been observed that the risk was increased in patients operated due to recurrent tonsillitis and older age group.

Comparison of treatment outcomes between intracapsular and total tonsillectomy for pediatric obstructive sleep apnea

BackgroundIntracapsular tonsillectomy (IT) has been advocated as a treatment for pediatric obstructive sleep apnea (OSA). However, evidence in the literature utilizing polysomnography (PSG) is limited. ObjectiveTo examine the experience at a tertiary children's hospital to evaluate the effectiveness and risks of intracapsular tonsillectomy compared to total tonsillectomy (TT) for treating pediatric OSA. MethodsA retrospective study was undertaken of pediatric tonsillectomy cases performed for OSA at a tertiary children's hospital from 2005 to 2010. Patients with recurrent tonsillitis, craniofacial abnormalities, chromosomal abnormalities, neuromuscular disease, and congenital malformations were excluded. Main outcome measures were apnea-hypopnea index (AHI), minimum oxygen saturation (minO2), and surgical complications. ResultsOf the 1583 patients reviewed in this study, there were 75 IT and 93 TT patients with pre- and post-operative PSG results. The IT patients were younger, had lower BMI, larger tonsil size, lower pre-operative (AHI) and lower post-operative AHI (p < 0.05). There was a similar percentage of patients that showed improvement in AHI and minimum oxygen saturation between the IT and TT groups. There were statistically similar average change in AHI and minimum oxygen saturation between the IT and TT groups at 5.6 ± 8.6 and 8.6 ± 12.9, respectively (p = 0.8) as well as similar improvement in minimum oxygen saturation between the two groups at 3.3% ± 4.3% and 3.0% ± 5.2%, respectively (p = 0.66). Of TT patients, 2.9% experienced post-operative bleeding with 1.6% requiring OR for control of hemorrhage. Of IT patients, 2.2% were found to have tonsillar regrowth with 2.0% returning to the OR for secondary tonsillectomy. ConclusionsIntracapsular tonsillectomy, like total tonsillectomy, is effective in improving polysomnogram results in appropriately selected children. Intracapsular tonsillectomy is a suitable option for the surgical treatment of pediatric OSA consequent to its demonstrated efficacy in relieving OSA and its favorable safety profile.

Acupuncture as an Antiemetic in Children who Underwent Adenoidectomy and/or Tonsillectomy

Postoperative vomiting (POV) is one of the most common problems following general anaesthesia, and many factors, either solely or in combination, may play a role in aetiology. Acupuncture is a technique that the World Health Organization has accepted as a complementary treatment. This study presents our experience with acupuncture for POV treatment in a study of paediatric tonsillectomy cases. The study included ASA I-II patients (n=70) aged 2-14 years who underwent tonsillectomy and/or adenoidectomy under general anaesthesia. The patients were randomly divided into the following two groups: control and study group. In the study group, an acupuncture needle was intraoperatively applied to the P6 acupuncture point for 20 min. Antiemetics were not administered to either group because of the standard applications in the preoperative period. The patients were postoperatively evaluated by nurses who were unaware about the techniques used in either group. No statistically significant difference was determined between the groups with regard to age, sex, nature of the operation, duration of anaesthesia, duration of the operation, surgical method and ASA scores. A statistically significant difference was determined between the groups with respect to vomiting rates. The acupuncture group presented with 0.28-times fewer vomiting episodes than the control group. The results of the study demonstrate that acupuncture has an apparent antiemetic efficacy in POV. Its routine use for POV may improve postoperative comfort and reduce drug use for prophylactic or therapeutic purposes.

口蓋扁桃摘出術後に投与する鎮痛薬別にみた鎮痛効果と術後出血の頻度:セレコキシブとロキソプロフェンの比較

Hemorrhage following tonsillectomy is still a major complication despite the progress in medical technology. Celecoxib is a selective COX-2 inhibitor and has a lower effect of platelet aggregation compared with conventional non-steroidal anti-inflammatory drugs (NSAIDs). We investigated whether or not the selection of celecoxib would reduce the risk of hemorrhage and provide a good analgesic effect following tonsillectomy in comparison with the use of loxoprofen (a conventional NSAID). We divided 107 cases of tonsillectomy into two groups by the kind of analgesic prescribed; the celecoxib group (n=55) and the loxoprofen group (n=52). Regarding the effective rate of the analgesic effect, the loxoprofen group scored 93.3% and the celecoxib group scored 68.6%. There was a significant difference between them (p=0.0003). Regarding side effects, the celecoxib group showed no side effects, whereas 8.0% of the loxoprofen group developed abdominal pain. There were no statistically significant differences between the changes in the VAS scale regarding the pain (p=0.834), the prescription periods of analgesic (p=0.485), the amount of food intake during the hospitalization (p=0.579), the rescue dosage rate (p=0.585), periods of usage (p=0.198) and the last dosage day. As for the tendency and the grade of postoperative hemorrhage, there were no statistically differences between the two groups (p=0.220). The rates of occurrence of late-onset hemorrhage (i.e. after the postoperative eleventh day) were 0.0% (0/11) in the the celecoxib group (n=11) and 31.2% (5/16) in the the loxoprofen group showing a statistically differences between them (p=0.049). Our results suggest that Celecoxib might reduce the risk of late-onset hemorrhage after the postoperative eleventh day with few side effects, so it could be a useful analgesic drug following tonsillectomy. However, it might be necessary to consider administration in combination with acetaminophen because Celecoxib has insufficient analgesic effect following tonsillectomy.

Discontinuing routine histopathological analysis after adult tonsillectomy for benign indication.

This study examines the rate of occult malignancy in routine histopathological analysis of tonsillectomy specimens from benign surgical cases in adults. Retrospective data review. 181 consecutive charts of tonsillectomies performed for benign indications between March 2007 and March 2014 were reviewed. Data on age, indications for surgery, preoperative and intraoperative clinical findings, and final pathology results were collected. A literature review of studies examining the rate of occult malignancy in tonsillectomy specimens was also performed, and the combined data was pooled. The financial impact of routine tonsil pathological analysis was determined. In 181 patients, there was one case of occult malignancy. After study inclusion and exclusion criteria were met, a review of the literature yielded 3,724 pooled tonsillectomy cases, with no case of unsuspected occult malignancy reported in the literature. The number needed to screen combining our series with the reported literature was 3,904. The financial impact of routine histopathological analysis at our institution was determined to be CAD $3308 per year. Routine pathological analysis of tonsil specimens recovered from surgery performed for benign indications, in the absence of any suspicion preoperatively for malignancy, is not supported by current evidence and is not financially sound. Modern evidence does not support the need for even gross specimen analysis in these cases.

Associations between socioeconomic status and race with complications after tonsillectomy in children.

To determine if disparities exist for revisits and complications after pediatric tonsillectomy. Cross-sectional analysis of multistate databases. Ambulatory surgery. Cases of pediatric tonsillectomy with or without adenoidectomy were extracted from state ambulatory surgery databases and linked to state emergency department databases and inpatient databases for California, Iowa, Florida, and New York for 2010 and 2011. Revisit rates and diagnoses within 14 days were analyzed for potential associations of these complications with sex, race, and median household income quartile. There were 79,520 cases of pediatric tonsillectomy that were extracted (50.3% male; mean age, 7.5 years). Overall, 6419 patients (8.1%) incurred a revisit after the procedure. Revisit rates for posttonsillectomy bleeding, acute pain, and fever/dehydration were 2.1%, 1.5%, and 2.2%, respectively. On multivariate analysis, increasing household income quartile was significantly associated with a decreasing rate of all complications: revisits (odds ratio [OR], 0.87; 95% confidence interval [CI], 0.84-0.89), posttonsillectomy bleeding (OR, 0.91; 95% CI, 0.86-0.96), acute pain (OR, 0.79; 95% CI, 0.74-0.84), and fever/dehydration (OR, 0.93; 95% CI, 0.89-0.98). Female sex was associated with a decreased rate of posttonsillectomy hemorrhaging (OR, 0.81; 95% CI, 0.73-0.91). Black and Hispanic children had an increased risk for a revisit after tonsillectomy (OR, 1.11; 95% CI, 1.01-1.22; and OR, 1.17; 95% CI, 1.09-1.26, respectively) and increased odds for acute pain at the revisit (OR, 1.36; 95% CI, 1.10-1.67; and OR, 1.34; 95% CI, 1.14-1.57, respectively) relative to white children. Race was not associated with the rate of hemorrhage posttonsillectomy. Significant disparities, particularly with respect to household income, exist in the incidence of revisits and complications after pediatric tonsillectomy. The disparate burden of increased revisits and acute pain diagnoses after tonsillectomy deserve further attention.

OSA and Postoperative Hemostasis Rate following Tonsillectomy at a Singapore Pediatric Tertiary Hospital

Objectives: Obstructive sleep apnea (OSA) has been hypothesized to be protective against postoperative tonsillectomy hemorrhage, presumably due to the upregulation of prothrombotic factors. This study investigates this possible correlation in patients at our institution. Methods: A 6-year retrospective case control study of tonsillectomy only and adenotonsillectomy cases done on children up to 16 years of age, from the end of January 2007 through the end of January 2013. The number of postoperative bleeds that required return to the operating room for hemostasis were recorded. Results: There were 2320 tonsillectomy cases. A total of 1581 were adenotonsillectomies and 730 were bilateral tonsillectomies only. Thirty-four cases returned to the operating room for hemostasis. Overall postoperative hemostasis rate was 1.47%. A total of 450 cases were listed as recurrent tonsillitis, 383 listed as OSA (confirmed on polysomnography [PSG]), and 1487 listed as adenotonsillar hypertrophy (no PSG done, presumed OSA). Of the 34 cases that returned to theatre, 9 were OSA cases, 8 were recurrent tonsillitis, and 17 were for hypertrophied tonsils (presumed OSA), giving a postoperative hemostasis rate of 1.39% for the OSA patients and 1.78% for recurrent tonsillitis. Conclusions: Despite the possible upregulation of prothrombotic factors in OSA, we found no real difference in postoperative tonsillectomy hemostasis rate in our patients, contrary to findings in other studies.

Tonsillectomy and IgA Nephropathy Recurrence After Kidney Transplantation.

[Background and purpose] The pathophysiology of IgA nephropathy (IgAN) remains poorly understood, although it frequently recurs after kidney transplantation, and its recurrence has been reported to depend on some factors. We studied a retrospective single-center analysis of renal transplant recipients with IgAN as the cause of end-stage renal failure to examine factors that may affect IgAN recurrence after kidney transplantation and the preventative and therapeutic effects of tonsillectomy on IgAN recurrence. [Material and method] From January 1987 to December 2012, 126 kidney transplantations were performed at Ryuku University Hospital, among which 14 cases (10 men; and 4 women) were identified with IgAN as their primary disease. Their mean age at transplantation was 38.1 ± 8.4 years.Donor types were as follows: 2 cadaveric, and 12 living (10 related; 2 unrelated). Tonsillectomy was performed for 8 cases; 2 were for therapeutic purposes for IgAN recurrence, and 6 were to prevent IgAN recurrence. IgAN recurrence diagnosis was based on light microscopic findings showing mesangioproliferative changes and mesangial IgA deposition on the basis of immunofluorescence analysis. [Result] Among the 14 patients, 2 cases were identified as IgAN recurrence based on episode biopsies. Both the recurrent cases had living related kidney donors. One patient with recurrent transplant IgAN progressed to graft failure 2.0 years after tonsillectomy, whereas the other subsequently retained renal function for 7.0 years. No pathological IgAN recurrence was found in 6 preventative tonsillectomy cases and in 2 cadaveric transplants that did not undergo tonsillectomy. Among 6 preventative tonsillectomy patients, 5 had improved urinary findings (protein urine and/or microscopic hematuria) after tonsillectomy. The 10 years living kidney donor graft survival rate of the IgAN group was lower than that of the non IgAN group (50 % vs. 88 %; P< 0.05). [Conclusion] Our data suggest that IgAN recurs more frequently after living related kidney transplantation than with cadaveric and living unrelated donor transplantation. Furthermore, no pathological IgAN recurrence was found after preventative tonsillectomy, and it was found that tonsillectomy could improve urinary findings. Thus, tonsillectomy has preventive and/or therapeutic effects for IgAN recurrence after kidney transplantation.

Five cases of tonsillectomy and steroid pulse therapy for recurrent immunoglobulin A nephropathy after kidney transplantation.

Five cases of recurrent immunoglobulin A nephropathy (IgAN) after kidney transplantation were successfully treated by tonsillectomy and steroid pulse therapy (SPT). The clinical background and pathology in the five cases were different, but good results were obtained in all of them. In cases 1 and 2, mild recurrent IgAN developed and failed to remit after tonsillectomy alone, but a remission was achieved in both cases after SPT. In case 3, highly active recurrent IgAN with crescent lesions developed 13 years after kidney transplantation, and a remission was achieved after SPT. In case 4, renal biopsy specimens showed pathological findings of recurrent IgAN with tubulitis, and hematuria and proteinuria resolved after SPT. In case 5, the biopsy findings indicated recurrent IgAN with chronic rejection. Tonsillectomy was followed by resolution of the proteinuria, and a remission was achieved after SPT. In conclusion, SPT is effective in inducing a remission of recurrent IgAN when tonsillectomy alone fails.

Postoperative Hemostasis Rate following Tonsillectomy at a Singapore Pediatric Tertiary Hospital

Objectives: Tonsillectomies and adenotonsillectomies are among the most common procedures to be carried out in children throughout the world. Postoperative hemorrhages have previously been reported to be at a maximum expected rate of 13.9% with a mean of 4.5%. This study reports the postoperative hemostasis rate at the KK Women’s and Children Hospital, Singapore, a tertiary pediatric hospital. Methods: Retrospective study of tonsillectomy and adenotonsillectomy cases done on children up to 16 years of age from the end of January 2007 till early January 2013. The number of postoperative bleeds that required return to the operating room for hemostasis was recorded. Results: In total there were 2322 tonsillectomy cases. 1581 were adenotonsillectomies, and 741 were bilateral tonsillectomies only (without adenoidectomy). There were 33 cases that required return to the operating room for hemostasis, giving a postoperative hemostasis rate of 1.42%. There were no cases of bleeding from adenoidectomy. All 2322 cases were done with monopolar diathermy. Hemostasis intraoperatively was also done with monopolar diathermy. The operating surgeons ranged from first year residents to senior consultants. Conclusions: The postoperative hemostasis rate following tonsillectomy and adenotonsillectomy at KK Women’s and Children’s Hospital is 1.42%, comparable to the best rates quoted in the literature .

Consenting for risk in common ENT operations: an evidence-based approach

Pre-operative consent discussion and documentation is an essential process that should follow relevant guidance, and include all serious or frequently occurring risks. We assessed the appropriateness of consent for grommet insertion, tonsillectomy, septoplasty, and hemithyroidectomy, by comparing the risks listed in current consenting practice to published complication data for the relevant operation. 120 consent forms and associated clinic letters were analysed. A literature search identified published complication data for comparison. There was great variation in consent practice for each operation type, and poor correlation with published risk incidence. Only 'bleeding' post-tonsillectomy and 'recurrent laryngeal nerve injury' post hemithyroidectomy were listed in 100 % of relevant cases. Common and serious complications were frequently omitted from forms. The number and type of risks consented for a procedure significantly differed between consultant and non-consultant staff. The potential requirement for blood transfusion was discussed in only 20 % of tonsillectomy cases. Currently, the pre-operative consent for commonly performed ENT operations does not reflect operative risks. Consenting for surgical complications should be evidence based using published or personal data. A change in the consent process is required to protect patient autonomy and meet both legal and professional body requirements.

A Prospective Study of Parents’ Compliance with Their Child's Prescribed Analgesia following Tonsillectomy

We conducted a prospective study to assess how well parents ensured that their children received their prescribed analgesia following tonsillectomy. Our study was based on 69 cases of tonsillectomy that were carried out at our tertiary pediatric care center. Postoperatively, all patients were prescribed paracetamol (acetaminophen) on the basis of their weight; the standard pediatric dosage of this agent at the time of our study was 60 mg/kg/day. The parents were telephoned 2 weeks postoperatively to assess their compliance with this regimen. Of the original 69 patients who had been recruited, 66 completed the study-35 girls and 31 boys, aged 2 to 15 years (mean: 7.0; median 5.5). According to the parents, only 15 children (22.7%) received our recommended 60-mg/kg/day dosage and were thus determined to be fully compliant. Overall, parents reported a wide variation in the amount of drug administered, ranging from 12.5 to 111.0 mg/kg/day (mean: 44.8), indicating that parents often underdose their children. We recommend that more emphasis be placed on weight-directed, parent-provided analgesia during the post-tonsillectomy period.