Our Summary

This research paper is about the feasibility of performing tonsillectomies (surgical removal of the tonsils) as day surgeries, meaning the patient can go home the same day as the operation, in Ireland. The research was conducted because, while this practice is common in the UK and other countries, it has been slow to be adopted in Ireland. The researchers believed that this method could help reduce long waiting times for ear, nose, and throat surgeries.

The study involved keeping track of several factors including patient demographics, surgical technique, how long patients stayed in the hospital, unsuccessful discharges, and rates of bleeding and readmission.

The results showed that there was a low rate of primary bleeding (bleeding within 24 hours of surgery) at 0.08%, and a secondary bleeding rate (bleeding after 24 hours) of 13.9%. Four patients had to return to the operating room to stop the bleeding, a rate of 3.5%. The surgical technique used did not affect the bleeding rate. The rate of unsuccessful discharges was 6%, and on average, patients were discharged roughly 7 hours after being extubated (removal of breathing tube).

The researchers concluded that performing tonsillectomies as day surgeries is safe, feasible, and efficient for a specific group of patients. This approach could help reduce waiting times for these surgeries and make more overnight hospital beds available for other cases. They note that their study represents the first instance of a two-year successful implementation of this practice in Ireland.

FAQs

  1. What was the purpose of introducing day case tonsillectomy?
  2. What were the results of the audit on day case tonsillectomy implementation?
  3. How did day case tonsillectomy affect waiting times for ENT surgery in Ireland?

Doctor’s Tip

A helpful tip a doctor might give a patient about tonsillectomy is to follow all post-operative care instructions carefully, including resting, drinking plenty of fluids, and avoiding strenuous activities. It is also important to watch for any signs of bleeding or infection and to contact the surgeon if any concerns arise.

Suitable For

Patients who are typically recommended for day case tonsillectomy include those who are otherwise healthy, have a low risk of complications, have good social support at home, and have a low risk of bleeding post-operatively. Patients with a history of significant bleeding disorders, obstructive sleep apnoea, or other medical conditions that may increase the risk of complications may not be suitable for day case tonsillectomy and may be recommended for an overnight stay in hospital. It is important for patients to be carefully selected for day case tonsillectomy to ensure the procedure is safe and successful.

Timeline

Before tonsillectomy:

  • Patient experiences recurrent tonsillitis or other tonsil-related issues that do not respond to other treatments.
  • Patient consults with an ENT specialist who recommends tonsillectomy.
  • Patient undergoes pre-operative assessment and preparation for surgery.
  • Patient receives instructions on fasting before surgery and post-operative care.

After tonsillectomy:

  • Patient undergoes tonsillectomy as a day case procedure.
  • Patient is monitored post-operatively for any complications such as bleeding or infection.
  • Patient is discharged home once stable and given instructions for pain management and follow-up care.
  • Patient may experience some pain and discomfort in the throat for a few days after surgery.
  • Patient follows up with the ENT specialist for post-operative assessment and to ensure proper healing.

What to Ask Your Doctor

  1. What are the potential risks and complications of a tonsillectomy procedure?

  2. How long is the recovery period expected to be after a tonsillectomy?

  3. What post-operative care will be needed following a tonsillectomy?

  4. How will pain management be handled after the procedure?

  5. What criteria are used to determine if a patient is a suitable candidate for a day case tonsillectomy?

  6. How will I know if I am experiencing a post-operative complication that requires medical attention?

  7. Are there any restrictions on activities or diet that I should follow after the procedure?

  8. What is the success rate of day case tonsillectomy in terms of preventing future tonsil-related issues?

  9. Will I need a follow-up appointment after the procedure, and if so, when should this be scheduled?

  10. How experienced is the surgical team in performing day case tonsillectomies, and what is their success rate with this procedure?

Reference

Authors: O’Riordan I, Garry S, Wauchope J, Lehane H, Mitchell M, Heffernan C, Phelan E. Journal: Ir Med J. 2022 Jan 20;115(1):518. PMID: 35279052