In attempts to minimize the cost of health care,
physicians are reducing the duration of hospital
stay. Traditionally, at the Hospital for Sick
Children, Toronto, otherwise healthy children
undergoing adenoidectomy, tonsillectomy or
adenotonsillectomy have been admitted the
morning of surgery and discharged from hospital
at 7 am the next day. The nursing records of
9409 patients aged 17 years or less who were
managed in this way between 1980 and 1984
were reviewed to determine the occurrence of
complications during the observation period. A
total of 202 patients (2.15%) bled during the
observation period. Of the 202, 6 (0.06% of all the
patients) required a second general anesthetic
for hemostasis; 1 of these 6 patients and 5 others
required blood transfusions. Discharge was delayed
for 42 patients (0.45% of all the patients)
because of postoperative bleeding and for 57
patients (0.6%) for a variety of other reasons.
Delayed discharge for reasons other than hemorrhage
was more frequent among children
less than 2 years of age and those over 12 years
of age. The authors concluded that children
undergoing adenoidectomy could safely be discharged
the same day after 6 hours of observation
following surgery. However, as a substantial
number of children bled from the tonsillar
fossa more than 6 hours after surgery, the
efficacy of periodic examination of the oral
cavity during the observation period in reducing
the rate of hemorrhage after 6 hours must be
evaluated before a same-day discharge program
is established for children undergoing adenotonsillectomy.
Par mesure d'economie, les medecin