Tonsillectomy: Does proximity from otolaryngology care influence the intra-operative or post-operative plan?

Abstract

Background: Tonsillectomy is one of the most common surgical procedures undertaken by Otolaryngologists. In Australia and New Zealand, decisions regarding clinical care may be influenced by the large geographic area serviced. The aim of this research was to identify if proximity from otolaryngology care influences intraoperative or postoperative management in tonsillectomy patients, particularly in regard to disposition. Secondary goals were to highlight trends in surgical demographics, technique and postoperative care. Methods: A 29-item survey examining preferences when performing tonsillectomy was sent to Fellows of the Australian and New Zealand Society of Otolaryngology Head and Neck Surgery (ASOHNS and NZSOHNS). Data was compiled and analysed using Microsoft ExcelTM. Results: A response rate of 33.1% in Australia (n=162/490) and 24.4% in New Zealand was achieved (n=32/131). Of the cohort, 61.7% of Australian and 25.0% of New Zealand surgeons would not offer tonsillectomy to patients if they resided more than 1 hour from an Ear, Nose and Throat (ENT)-serviced hospital and intended to go home on day 1 postoperatively. Australian surgeons were more inclined to counsel patients to remain for 10–14 days than colleagues in New Zealand (52.6% vs. 9.4%). The majority of surgeons did not alter their operative technique (85.0% of Australians and 90.1% of New Zealand Surgeons). Conclusions: Australian surgeons are more likely to counsel patients to remain in close proximity post tonsillectomy. Postoperative proximity to ENT services did not instigate a change in operative technique or analgesic regime for either children or adults. Disparities in preferred surgical technique and analgesia were identified.