What are the discharge criteria from the clinic after follow-up for post-tonsillectomy patients?

From the Guidelines

Patients can be discharged from the clinic after post-tonsillectomy follow-up when they meet specific criteria, including adequate healing, absence of complications, and resolution of significant symptoms, as outlined in the clinical practice guideline for tonsillectomy in children 1. The discharge criteria should include complete wound healing with no signs of infection, ability to maintain adequate oral hydration and nutrition, pain controlled with oral medications, absence of significant bleeding, and resolution of any post-operative complications. According to the guideline 1, pain control after tonsillectomy is essential for minimizing postoperative morbidity, and clinicians should advocate for pain management after tonsillectomy and educate caregivers about the importance of managing and reassessing pain. Some key points to consider when discharging patients after post-tonsillectomy follow-up include:

• The use of ibuprofen, acetaminophen, or both for pain control after tonsillectomy, as recommended by the guideline 1
• Avoidance of the use of codeine or any medication containing codeine after tonsillectomy, due to the FDA black box warning against codeine use in children after tonsillectomy 1
• The need for overnight inpatient monitoring of children after tonsillectomy if they are <3 years old or have severe OSA, as recommended by the guideline 1
• The importance of follow-up with individual patients and/or caregivers after tonsillectomy to document the presence or absence of bleeding, as recommended by the guideline 1 Patients should be instructed to seek immediate medical attention if they experience bright red bleeding, severe pain uncontrolled by prescribed medications, inability to swallow, high fever above 101.5°F (38.6°C), or signs of dehydration. A final follow-up appointment may be scheduled 4-6 weeks after surgery to confirm complete recovery, as this allows for adequate healing of the tonsillar fossae and ensures that the risk of delayed hemorrhage has significantly decreased.

From the Research

Discharge Criteria for Post-Tonsillectomy Patients

To determine the appropriate discharge criteria for post-tonsillectomy patients, several factors must be considered, including pain management, risk of bleeding, and patient education.

• The study by 2 found that the median duration of pain cessation was 11 days, and the median duration of analgesic treatment was 12 days, indicating that patients may require ongoing pain management after discharge.
• The study by 3 highlighted the importance of patient education, as many patients were unaware of the symptoms they might expect post-operatively, despite receiving written and verbal information.
• In terms of bleeding risk, the study by 4 found that ibuprofen may increase the risk of postoperative hemorrhage, although the study by 5 found no statistically significant increased risk of post-tonsillectomy hemorrhage when ibuprofen is prescribed at commonly used clinical dosages.

Post-Discharge Care

After discharge, patients should be instructed on how to manage their pain and recognize signs of complications, such as bleeding.

• The study by 6 found that ibuprofen with acetaminophen is a safe and effective analgesic regimen for post-tonsillectomy pain management, although the risk of bleeding should be carefully considered.
• The study by 2 found that ketoprofen combined with paracetamol-codeine provided sufficient analgesia for most patients at home, but ketoprofen may cause an increase in the secondary hemorrhage rate and should be prescribed with caution.

Patient Education

Patient education is crucial to ensure that patients are aware of the potential complications and can seek medical attention if necessary.

• The study by 3 found that patients often failed to recognize the importance of potentially life-threatening complications, such as secondary hemorrhage from the tonsillar bed.
• The study by 2 found that patients should be educated on the signs and symptoms of bleeding and instructed to seek medical attention immediately if they experience any unusual bleeding or other concerning symptoms.