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Will improving pain in paediatric tonsillectomy patients decrease hospital readmissions?

William Milligan, Catherine Vass
University Hospital Monklands, Glasgow, United Kingdom


Introduction: Paediatric tonsillectomies are one of the most common surgical procedures, with approximately 30,000 carried out, in England, annually. Observational data has shown no difference in complication rates between day and admitted cases making day case advantageous from a patient satisfaction, cost and resource perspective. However, 30-day readmission rates have been estimated to be 7.8% most commonly for bleeding and pain. Our aim was to assess readmission rates of tonsillectomy patients and consider ways to reduce this.

Methods: Using the OPERA system, data for paediatric tonsillectomies in our district general hospital in a six-month period was collated. Each case was individually reviewed, with rates and reasons for readmission recorded. Given pain is a key reason for readmission a patient information leaflet on the use of morphine in the community was developed alongside staff education and training on the new initiative.

Results: Twenty-five patients underwent tonsillectomy in the six-month period (mean age – 8 years). One patient remained an inpatient due to pain, with 20% (5/25) representing with bleeding or pain. Three were subsequently readmitted (12%). The information leaflet is being finalised and training is currently ongoing. Further data collection will take place after these measures have been introduced.

Conclusions: The British Association of Day Surgery aim for 80% of paediatric tonsillectomies to be done as day cases, our site meets this target. To improve patient experience, cost and resource usage work must to be done to maximise day case tonsillectomies and reduce hospital readmission rates.