Day surgery for tonsils safe, say Starship doctors

Removing children's tonsils in a day-surgery clinic is safe, a study at the Starship children's hospital in Auckland found.

Day-stay tonsillectomy - as opposed to being admitted to hospital for an overnight stay - has been controversial in Britain and in Australia, say Starship doctors writing in an international journal.

Tonsillectomy is one of the most common surgical procedures in New Zealand.

The Starship report is based on a nine-year audit, in which time 4850 tonsillectomies were performed at the hospital, 80 per cent of them as day-stay procedures.

Less than 1 per cent suffered a haemorrhage within 24 hours of surgery and most of these bleeds occurred during the four-hour post-surgery observation period. Less than 0.5 per cent needed re-operation to control bleeding.

"No child with a primary haemorrhage who presented after discharge following day-stay surgery required re-operation or blood transfusion.

"Day-stay surgery was planned in 4041 children and 4.7 per cent required conversion to hospital admission. Post-operative vomiting was the most common indication for conversion, while haemorrhage contributed only 0.95 per cent.

"Paediatric day-stay tonsillectomy is a safe procedure when performed with strict preoperative criteria, trained day-stay unit staff, and with in-patient facilities on site," the report's authors conclude in their article, published in the International Journal of Paediatric Otorhinolaryngology.

Starship ear, nose and throat clinical director Colin Brown - one of the authors - said pressure on hospital beds prompted the initial move towards day-stay tonsillectomies at Starship.

It was also better for children, who preferred the familiar surroundings of their home to a stay in hospital.

The overseas controversy about day-stay tonsillectomy was because of fears patients might have a significant haemorrhage soon after the operation, but the audit weakened that argument.

"The greatest haemorrhage rate was in days six to 10, so the idea of keeping someone in hospital for the first night is not altogether sensible."