International Journal of Pediatric Otorhinolaryngology
Review articleOne-day surgery in pediatric otolaryngology—10 years’ experience
Introduction
In children, surgery involving the ear, nose or throat is usually carried out with the patients staying in hospital. The child can be prepared for the procedure, followed during recovery and receive appropriate treatment immediately, if complications occur. Today, procedures followed by several hours of hospitalization known as 1-day surgery are beginning to gain wide acceptance [1]. The advantages include a shorter absence of the child from home, hospital cost reduction, shorter waiting period for elective surgery and an increase in the rate of patient turnover [2].
The indications for 1-day surgery in pediatric otolaryngology are as follows: short surgical or diagnostic procedures, such as adenoidectomy, otomicroscopic examination involving insertion or removal of ventilation tubes, foreign body removal, examination under general anaesthesia and removal of minor superficial lesions in the head and neck regions.
One-day surgery, compared to a longer hospital stay, is more demanding in terms of organization. First of all, it requires good co-operation with the parents. Also, not every patient can be included in a 1-day surgery programme. The patient must be healthy (at level I or II by the American Society of Anesthesiologists, ASA) and have a good social background and co-operating and responsible parents.
Surgery can be carried out under local or general anaesthesia. The latter is better and safer in pediatric medicine [3]. In adenoidectomy particularly, it allows us to remove adenoid tissue completely and stop bleeding properly in a calm child who, in addition, has no memories of the procedure.
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Materials and methods
The surgical day care unit was opened at the Pediatric Otolaryngology Clinic in 1996. During last 10 years of operation, a total of 12,331 children, between 2 and 18 years of age, were treated there. All surgical procedures were carried out under general anaesthesia.
The indication criteria for 1-day surgery were established by our department in co-operation with the Anaesthetics and Acute Care Department as follows:
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2 years of age and older;
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good health state (ASA level I or II);
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car
Results
The data on the 12,331 children treated during the 10-year period were retrospectively evaluated and categorized according to the kind of procedure performed and complications requiring overnight hospital stay (Table 1).
All surgical and diagnostic procedures were performed under general anaesthesia. Adenoidectomy and adenoidectomy combined with otomicroscopy or frenulectomy were carried out in 11,061 patients (89.7%). The rest of the patients underwent minor surgeries or diagnostic procedures
Discussion
Minor surgical procedures in pediatric otolaryngology can be performed on a hospital stay or day care basis. A stay in hospital usually lasts 3 days. The child is admitted 1 day before the treatment for pre-surgery evaluation and adaptation to the hospital environment. Surgery under general anaesthesia is carried out the following day and the child is discharged from hospital in the morning of the third day after a ward round.
This care is usually provided for children who live at a distance
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