A new Getting It Right First Time (GIRFT) paper examining the safety of paediatric tonsillectomy carried out as day surgery has concluded there is no strong or consistent evidence that children seen as a day case have poorer outcomes than those who stay overnight in hospital.
In a study to be published on the Anaesthesia journal website – run by the Association of Anaesthetists – the authors show that same day discharge of children (aged between two and 18) who have had their tonsils removed at non-specialist trusts does not lead to more emergency readmissions within 30 days. Among children operated on at specialist trusts, there is only a very modest increase in readmission rates.
The study concludes that all trusts, in particular specialist centres, should examine reasons for low day case rates and aim for 70% or more of suitable paediatric patients to have their tonsillectomy as day case, in line with targets set by the British Association of Day Surgery (BADS).
Read The safety of day-case paediatric tonsillectomy in England in full here.
The GIRFT authors took part in a live discussion on Twitter in September 2021. Follow this link to view.
The study analysed Hospital Episode Statistics (HES) data on almost 150,000 paediatric tonsillectomies carried out in 133 trusts between 2014 and 2019. Day case rates at non-specialist trusts stood at 62%, while at specialist trusts they were 50%.
The findings support the 2019 GIRFT national specialty report for ear, nose and throat (ENT) surgery, which stated that an increase in same day discharge for tonsillectomy could improve efficiency, helping to reduce waiting lists and freeing up beds for patients who need them.
As the NHS works to restore elective surgery post-pandemic, efficient methods of working are more important than ever. The new study also offers evidence to support GIRFT’s high volume low complexity (HVLC) programme, which enables NHS systems to establish day surgery as the default for many procedures performed frequently, including tonsillectomy, to help tackle the elective surgery backlog.
The Anaesthesia study was authored by:
- William K Gray: GIRFT senior research associate
- Arunjit Takhar: fellow in head and neck surgical oncology at Manchester University NHS Foundation Trust
- Annakan Navaratnam: honorary GIRFT fellow and ENT surgeon
- Jamie Day: retired chief information officer for GIRFT
- Michael Swart: GIRFT joint clinical lead for anaesthesia and perioperative medicine
- Chris Snowden: GIRFT joint clinical lead for anaesthesia and perioperative medicine
- Tim Briggs: Chair of GIRFT and National Director of Clinical Improvement for the NHS
- Andrew Marshall: GIRFT clinical lead for ENT surgery and author of the 2019 national report.