Postoperative recovery in children after outpatient ENT surgery.

OBJECTIVE: To provide a comprehensive description of postoperative recovery after routine outpatient ENT procedures in children and to compare parental estimations to the child's self-reported ratings of postoperative pain. METHODS: For 14 days after surgery, we monitored pain, nausea or vomiting, problems with eating and fluid intake, sleep disturbances, behavioral changes, emotional impact, other types of discomfort, rehospitalization, and duration to full recovery, based on diary entries and telephone calls. RESULTS: 69 children and their parents participated. After inserting ventilation tubes, the average recovery time was 4.6 days. Symptoms were most intense during the first three days. Participants mainly reported pain, behavioral changes, and emotional impact. After more extensive ENT surgery (adenoidectomy and/or tonsillectomy, with or without insertion of ventilation tubes), the average recovery time was 6.2 days, and pain was more severe and longer-lasting. Apart from nausea or vomiting during the first three days, participants frequently reported behavioral changes, emotional impact, and sleep disturbances. Problems with eating and fluid intake were most prevalent. Pain scores reported by parents differed from the scores reported by their children; parents both underestimated and overestimated their child's pain. CONCLUSION: This study provided descriptions of postoperative recovery after outpatient ENT surgery in children. This information is indispensable for preparing the child and parents and for ensuring accurate follow-up. Recovery varied with the type of surgery. Mainly, postoperative discomfort was most severe after adenoidectomy and/or tonsillectomy. Parents tended to give inaccurate estimates of their child's pain. Self-reports from children should be considered the gold standard.

ENT one day surgery: critical analysis with the HFMEA method.

OBJECTIVES: Research shows that 51.4% of adverse events in hospitals occur in surgery and that 3-22% of surgical patients experience adverse events. The risk may be even higher when turnover is high and when patients are children, as is often the case in ear, nose and throat surgery. This quality project therefore started in response to requests from physicians in two hospitals in the Flemish part of Belgium. The aim of this study is to use the Healthcare Failure Mode & Effect Analysis method to evaluate the process flow for ear, nose and throat patients, and to redesign the process to enhance patient safety. METHODOLOGY: In two One Day Clinics, processes were prospectively analysed using the Healthcare Failure Mode & Effect Analysis method. RESULTS: Similar potential failures were reported in both hospitals. The major failure mode was linked to the absence of an active identity check throughout the process. The process was therefore redesigned by implementing a surgical safety checklist and an active identity check protocol. Although the Healthcare Failure Mode & Effect Analysis is a time-consuming method, this systematic approach by a multidisciplinary team has been found to be useful in detecting failure modes that need immediate safety responses. The involvement of all disciplines and an open safety culture during the procedure were the most important conditions. CONCLUSIONS: The Healthcare Failure Mode & Effect Analysis is a useful instrument for detecting the failure modes in this care process.

Outpatient hemithyroidectomy: safety and feasibility.

OBJECTIVE: In Belgium, thyroidectomy is currently an inpatient procedure because of potential life-threatening post-operative complications that include hypocalcemia, laryngeal nerve damage and haemorrhage. Thyroidectomy can only be performed on an outpatient basis if the complication rate is low. The purpose of this study was to determine the feasibility and safety of outpatient hemithyroidectomy. METHODOLOGY: Between March 2008 and September 2010 we selected 54 patients who met our inclusion criteria for outpatient hemithyroidectomy. The procedure was carried out through a standard cervicotomy under general anaesthesia. No drains were used. We analysed patient outcome based on complications, unplanned admissions and readmissions. RESULTS: The mean age of the 54 patients was 46 years, and most of them were women (81%). The mean duration of surgery was 64 minutes, and there were no intra-operative complications. After an observation period of at least 3 hours, 44 patients (81.5%) were discharged as planned. Ten patients (18.5%) required admission for urine retention (n = 1), social circumstances (n = 1), persistence of nausea (n = 3), delayed anaesthesia recovery (n = 4) and patient preference (n = 1). All 10 were discharged the next day, and none were readmitted. CONCLUSIONS: Our study shows that outpatient hemithyroidectomy performed by experienced surgeons in carefully selected patients can be safe and is associated with a low complication rate. However, this series is small and larger studies are needed to confirm the results.