Division of Otolaryngology-Head and Neck Surgery, McMaster University, Canada; McMaster University Medical Centre, Hamilton Health Sciences, Canada.
Michael G. DeGroote School of Medicine, McMaster University, Canada.
Int J Pediatr Otorhinolaryngol. 2020 Nov;138:110314. doi: 10.1016/j.ijporl.2020.110314. Epub 2020 Aug 12.
Tonsillectomy is the most common pediatric surgery in Canada. Post-tonsillectomy 30-day Emergency Department (ED) visit rates are higher than other pediatric day surgeries. To date, there have been no studies assessing whether additional preoperative education directed by Child Life Specialists impacts preventable ED visits. The primary aim of this study was to evaluate whether additional preoperative tonsillectomy education is feasible and is associated with fewer ED visits and admissions in the immediate postoperative period compared to standard care. The secondary aim of this study was to assess whether this education was associated with a lower ED visit rate for preventable causes.
This is a retrospective chart review conducted in an academic tertiary pediatric hospital. Patients undergoing tonsillectomy surgery (from 2014 to 2019) were divided into three groups: consultation with a Child Life Specialist plus educational Booklet plus traditional surgeon-led education (CLS), educational Booklet plus surgeon-led education (Booklet), and traditional surgeon-led education (Traditional). The feasibility of the CLS education was assessed and the 30-day ED visit and admission rates were compared between groups. Visits included patients who returned to ED post-tonsillectomy and were not admitted, whereas admission included those who returned to ED and were admitted.
2081 patients undergoing tonsillectomy were included. 329 (15.8%) presented to the ED (within a median of 5 days), and 92 (4.4%) were admitted. ED visit/admission rates by group were: 14.7%/4.4% (CLS), 15.8%/4.1% (Booklet), and 16.2%/4.7% (Traditional) (p = 0.81/p = 0.84). The most common reason for return to ED was Hemorrhage (4.9%). Patients also returned to the ED for preventable reasons such as dehydration, pain, nausea/vomitting and fevers.
Additional preoperative tonsillectomy education is feasible but is not associated with fewer ED visits and admissions, or fewer ED visits for preventable causes. Further research is needed to identify the optimal intervention to address the high post-tonsillectomy ED visit rate.
扁桃体切除术是加拿大最常见的儿科手术。扁桃体切除术后 30 天内急诊就诊率高于其他儿科日间手术。迄今为止，尚无研究评估儿童生活专家指导的额外术前教育是否会影响可预防的急诊就诊。本研究的主要目的是评估额外的扁桃体切除术术前教育是否可行，并与标准护理相比，在术后即刻是否与更少的急诊就诊和入院相关。本研究的次要目的是评估这种教育是否与可预防原因导致的急诊就诊率降低相关。
这是在一家学术性三级儿科医院进行的回顾性图表审查。接受扁桃体切除术手术的患者（2014 年至 2019 年）分为三组：与儿童生活专家咨询+教育手册+传统外科医生主导的教育（CLS）、教育手册+外科医生主导的教育（手册）和传统外科医生主导的教育（传统）。评估 CLS 教育的可行性，并比较各组之间 30 天内急诊就诊和入院率。就诊包括扁桃体切除术后返回急诊但未住院的患者，而住院包括返回急诊并住院的患者。
共纳入 2081 例接受扁桃体切除术的患者。329 例（15.8%）在术后中位数 5 天内就诊于急诊，92 例（4.4%）住院。按组划分的急诊就诊/住院率分别为：14.7%/4.4%（CLS）、15.8%/4.1%（手册）和 16.2%/4.7%（传统）（p=0.81/p=0.84）。返回急诊的最常见原因是出血（4.9%）。患者也因脱水、疼痛、恶心/呕吐和发热等可预防的原因返回急诊。
额外的术前扁桃体切除术教育是可行的，但与较少的急诊就诊和入院或较少的可预防原因导致的急诊就诊无关。需要进一步研究以确定解决高扁桃体切除术后急诊就诊率的最佳干预措施。
