Hostname: page-component-8448b6f56d-xtgtn Total loading time: 0 Render date: 2024-04-16T14:56:36.488Z Has data issue: false hasContentIssue false
  • English
  • Français

Day-case tonsillectomy for children in Glasgow: the impact of changing indications and deprivation

Published online by Cambridge University Press:  05 March 2013

W A Clement
W A Clement*
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Royal Hospital for Sick Children, Glasgow, Scotland, UK
*
Address for correspondence: Mr W A Clement, Department of Otolaryngology – Head and Neck Surgery, Royal Hospital for Sick Children, Glasgow G3 8SJ, Scotland, UK Fax: 0141 2010865 E-mail: wclement@nhs.net
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To determine the number of children undergoing tonsillectomy that could have this performed as a day surgery procedure.

Methods:

This paper reports a prospective cohort study, which entailed a comparison of children's eligibility for day-case surgery between 2001 and 2011 and an assessment of the Scottish Index of Multiple Deprivation scores.

Results:

In total, 148 children were enrolled. In 2011, 60 children (42 per cent) were eligible for surgery with same day discharge compared with 27 per cent in 2001. The percentage of children undergoing tonsillectomy for sleep-related breathing disorders or obstructive sleep apnoea hypopnoea syndrome increased from 26 per cent to 55 per cent.

Conclusion:

Eligibility for tonsillectomy with same day discharge has increased. This appears to be related to an increase in the number of children who are able to fulfil the social criteria for same day discharge. The results indicate an association between deprivation and tonsillectomy, particularly surgery carried out for the symptoms of sleep-related breathing disorders or obstructive sleep apnoea hypopnoea syndrome. There has been a significant increase in the percentage of children undergoing tonsillectomy for the indication of sleep-related breathing disorders or obstructive sleep apnoea hypopnoea syndrome.

Keywords

AdenoidectomyAmbulatory Surgical ProceduresAuditDeprivationSocioeconomic FactorsTonsillectomy
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 127 , Issue 4 , April 2013 , pp. 392 - 398
Copyright
Copyright © JLO (1984) Limited 2013

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Brigger, MT, Brietzke, SE. Outpatient tonsillectomy in children: a systematic review. Otolaryngol Head Neck Surg 2006;135:1–7CrossRefGoogle ScholarPubMed
2Bhattacharyya, N. Ambulatory pediatric otolaryngologic procedures in the United States: characteristics and perioperative safety. Laryngoscope 2010;120:821–5CrossRefGoogle ScholarPubMed
3Bisset, AF, Russell, D. Grommets, tonsillectomies, and deprivation in Scotland. BMJ 1994;308:1129–32CrossRefGoogle ScholarPubMed
4Drake-Lee, A, Harris, S. Social conditions and paediatric day case tonsillectomy. J Health Serv Res Policy 1999;4:101–5CrossRefGoogle ScholarPubMed
5Parker, NP, Walner, DL. Trends in the indications for pediatric tonsillectomy or adenotonsillectomy. Int J Pediatr Otorhinolaryngol 2011;75:282–5CrossRefGoogle ScholarPubMed
6Bhattacharyya, N, Lin, HW. Changes and consistencies in the epidemiology of pediatric adenotonsillar surgery, 1996–2006. Otolaryngol Head Neck Surg 2010;143:680–4CrossRefGoogle ScholarPubMed
7Erickson, BK, Larson, DR, St Sauver, JL, Meverden, RA, Orvidas, LJ. Changes in incidence and indications of tonsillectomy and adenotonsillectomy, 1970–2005. Otolaryngol Head Neck Surg 2009;140:894–901CrossRefGoogle ScholarPubMed
8The Royal College of Surgeons of England. Guidelines for Day Case Surgery. London: RCSENG - Professional Standards and Regulation, 1992Google Scholar
9Brown, OE, Cunningham, MJ. Tonsillectomy and Adenoidectomy Inpatient Guidelines: recommendations of the AAO-HNS Pediatric Otolaryngology Committee. American Academy of Otolaryngology—Head and Neck Surgery Bulletin 1996;15:1–4Google Scholar
10Kishore, A, Haider-Ali, AM, Geddes, NK. Patient eligibility for day case paediatric adenotonsillectomy. Clin Otolaryngol Allied Sci 2001;26:47–9CrossRefGoogle ScholarPubMed
11SIMD postcode lookup. In: http://www.scotland.gov.uk/Topics/Statistics/SIMD/SIMDPostcodeLookup [17 January 2012]Google Scholar
122-way contingency table analysis. In: http://statpages.org/ctab2x2.html [29 February 2012]Google Scholar
13Statistics. In: http://www.fon.hum.uva.nl/Service/Statistics.html [29 February 2012]Google Scholar
14Total procedures and interventions. In: http://www.hesonline.nhs.uk/Ease/servlet/ContentServer?siteID=1937&categoryID=210 [17 January 2012]Google Scholar
15Segerdahl, M, Warrén-Stomberg, M, Rawal, N, Brattwall, M, Jakobsson, J. Children in day surgery: clinical practice and routines. The results from a nation-wide survey. Acta Anaesthesiol Scand 2008;52:821–8CrossRefGoogle ScholarPubMed
16Kanerva, M, Tarkkila, P, Pitkäranta, A. Day-case tonsillectomy in children: parental attitudes and consultation rates. Int J Pediatr Otorhinolaryngol 2003;67:777–84CrossRefGoogle ScholarPubMed
17The Royal College of Surgeons of England. National Prospective Tonsillectomy Audit. London: The Royal College of Surgeons of England, 2005Google Scholar
18Kubba, H, Messersmith, R. Is day case tonsillectomy suitable for children in Cumbria? Clin Perform Qual Health Care 1999;7:130–3Google ScholarPubMed
19Yardley, MP, Fairley, JW, Durham, LH, Parker, AJ. Day case tonsil and adenoid surgery: how many are eligible? J R Coll Surg Edinb 1994;39:162–3Google ScholarPubMed
20Drake-Lee, A, Weiner, G. Suitability of children for ENT day case procedures. Clin Otolaryngol Allied Sci 1997;22:215–18CrossRefGoogle ScholarPubMed
21Drake-Lee, A, Stokes, M. A prospective study of the length of stay of 150 children following tonsillectomy and/or adenoidectomy. Clin Otolaryngol Allied Sci 1998;23:491–5CrossRefGoogle ScholarPubMed
22Shah, C, Shahab, R, Robb, P, Roy, D. Role of a home care team in paediatric day-case tonsillectomy. J Laryngol Otol 2001;115:39–43CrossRefGoogle ScholarPubMed
23Hellier, WP, Knight, J, Hern, J, Waddell, T. Day case paediatric tonsillectomy: a review of three years experience in a dedicated day case unit. Clin Otolaryngol Allied Sci 1999;24:208–12CrossRefGoogle Scholar
24Shott, SR, Myer, CM 3rd, Cotton, RT. Efficacy of tonsillectomy and adenoidectomy as an outpatient procedure: a preliminary report. Int J Pediatr Otorhinolaryngol 1987;13:157–63CrossRefGoogle ScholarPubMed
25Truy, E, Merad, F, Robin, P, Fantino, B, Morgon, A. Failures in outpatient tonsillectomy policy in children: a retrospective study in 311 children. Int J Pediatr Otorhinolaryngol 1994;29:33–42CrossRefGoogle ScholarPubMed
26Chaplin, J, Stevenson, S, Stewart, I. Paediatric day surgery adenotonsillectomy in New Zealand. Aust J Otolaryngol 1995;2:11–15Google Scholar
27Leong, AC, Davis, JP. Morbidity after adenotonsillectomy for paediatric obstructive sleep apnoea syndrome: waking up to a pragmatic approach. J Laryngol Otol 2007;121:809–17CrossRefGoogle ScholarPubMed
28Blenke, EJ, Anderson, AR, Raja, H, Bew, S, Knight, LC. Obstructive sleep apnoea adenotonsillectomy in children: when to refer to a centre with a paediatric intensive care unit? J Laryngol Otol 2008;122:42–5CrossRefGoogle ScholarPubMed
29Clement, WA, Dempster, JH. Implementation by Scottish otolaryngologists of the Scottish Intercollegiate Guidelines Network document Management of Sore Throats and the Indications for Tonsillectomy: four years on. J Laryngol Otol 2004;118:357–61CrossRefGoogle Scholar
30Management of sore throat and indications for tonsillectomy. A national clinical guideline. In: http://www.sign.ac.uk/pdf/sign117.pdf [24 January 2012]Google Scholar
31Baugh, RF, Archer, SM, Mitchell, RB, Rosenfeld, RM, Amin, R, Burns, JJ et al. Clinical practice guideline: tonsillectomy in children. Otolaryngol Head Neck Surg 2011;144(Suppl 1):S1–30CrossRefGoogle ScholarPubMed
32Robb, PJ, Bew, S, Kubba, H, Murphy, N, Primhak, R, Rollin, AM et al. Tonsillectomy and adenoidectomy in children with sleep-related breathing disorders: consensus statement of a UK multidisciplinary working party. Ann R Coll Surg Engl 2009;91:371–3CrossRefGoogle ScholarPubMed
33Section on Pediatric Pulmonology, Subcommittee on Obstructive Sleep Apnea Syndrome. American Academy of Pediatrics. Clinical practice guideline: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2002;109:704–12CrossRefGoogle Scholar
34Roland, PS, Rosenfeld, RM, Brooks, LJ, Friedman, NR, Jones, J, Kim, TW et al. Clinical practice guideline: polysomnography for sleep-disordered breathing prior to tonsillectomy in children. Otolaryngol Head Neck Surg 2011;145(Suppl 1):S1–15Google ScholarPubMed
35Working party on sleep physiology and respiratory control disorders in childhood: standards for services for children with disorders of sleep physiology. In: http://www.rcpch.ac.uk/sites/default/files/asset_library/Research/Clinical%20Effectiveness/Endorsed%20guidelines/Sleep%20Physiology%20Disorders%20%28RCPCH%29/Report%20TextC.pdf [4 January 2013]Google Scholar
36Saito, H, Araki, K, Ozawa, H, Mizutari, K, Inagaki, K, Habu, N et al. Pulse-oximetery is useful in determining the indications for adeno-tonsillectomy in pediatric sleep-disordered breathing. Int J Pediatr Otorhinolaryngol 2007;71:1–6CrossRefGoogle ScholarPubMed
37Kirk, VG, Bohn, SG, Flemons, WW, Remmers, JE. Comparison of home oximetry monitoring with laboratory polysomnography in children. Chest 2003;124:1702–8CrossRefGoogle ScholarPubMed
38Nixon, GM, Kermack, AS, Davis, GM, Manoukian, JJ, Brown, KA, Brouillette, RT. Planning adenotonsillectomy in children with obstructive sleep apnea: the role of overnight oximetry. Pediatrics 2004;113:e19–25CrossRefGoogle ScholarPubMed
39Brown, KA, Morin, I, Hickey, C, Manoukian, JJ, Nixon, GM, Brouillette, RT. Urgent adenotonsillectomy: an analysis of risk factors associated with postoperative respiratory morbidity. Anesthesiology 2003;99:586–95CrossRefGoogle ScholarPubMed
40Weatherly, RA, Mai, EF, Ruzicka, DL, Chervin, RD. Identification and evaluation of obstructive sleep apnea prior to adenotonsillectomy in children: a survey of practice patterns. Sleep Med 2003;4:297–307CrossRefGoogle ScholarPubMed
41Guidance on the provision of paediatric anaesthesia services. In: http://www.rcoa.ac.uk/docs/gpas-paeds.pdf [1 February 2012]Google Scholar
42Croxford, R, Friedberg, J, Coyte, PC. Socio-economic status and surgery in children: myringotomies and tonsillectomies in Ontario, Canada, 1996–2000. Acta Paediatr 2004;93:1245–50CrossRefGoogle ScholarPubMed
43Brouillette, RT, Horwood, L, Constantin, E, Brown, K, Ross, NA. Childhood sleep apnea and neighborhood disadvantage. J Pediatr 2011;158:789–95CrossRefGoogle ScholarPubMed
44Boss, EF, Smith, DF, Ishman, SL. Racial/ethnic and socioeconomic disparities in the diagnosis and treatment of sleep-disordered breathing in children. Int J Pediatr Otorhinolaryngol 2011;75:299–307CrossRefGoogle ScholarPubMed