Does day case pediatric tonsillectomy increase postoperative pain compared to overnight stay pediatric tonsillectomy? A prospective comparative audit.

BACKGROUND: Clinical and financial pressures in the United Kingdom's National Health Service have been a stimulus for change from overnight stay to day case surgery for many procedures, including pediatric tonsillectomy. There are no prospective studies to assess whether such a change in practice alters children's experiences of pain and perioperative morbidity. Therefore, we undertook a prospective audit to measure these adverse outcomes during this change of practice in our unit.
METHODS: Sixty children aged between 3 and 15 years who required tonsillectomy were recruited to this prospective comparative audit. Children received treatment on either an overnight stay (n = 28) or day case (n = 32) basis following a strict perioperative care pathway. The primary endpoints were the pain scores reported using a visual analogue scale, and secondary endpoints were vomiting, consultation with healthcare providers, readmission and patient satisfaction. Outcome data were collected from parents at 24 h and 7 days.
RESULTS: There was a small, but significant, risk of greater baseline pain scores in the day case surgery group during the first 24 h. However, there was no difference in the worst pain experienced during the first 24 h, or any pain experienced at 7 days. There was no difference in any of the secondary outcome measures between the groups.
CONCLUSIONS: Change in practice from overnight stay to day case surgery for pediatric tonsillectomy requires careful consideration of how to extend effective analgesia for this painful procedure into the home.