Day Case Adenotonsillectomy in Children: How Useful are Routine Pre-Operative Basic Investigations in a Private Hospital Setting?

Abstract

Background: Safe day-case surgery depend on proper pre-operative investigations besides safe anaesthesia and general health of the patients. In an attempt to ensure safety, investigations such as full blood count, electrolyte and urea are often carried out routinely while other investigations like electrocardiogram and chest x-rays are sometimes requested based on the presentations of these patients. These investigations are routinely requested as the minimum requirement prior to day case surgery, but how useful are these investigations? The aim of this paper is to highlight the usefulness of these baseline investigations vis-à-vis the complications of day case surgery (tonsillectomy, adenotonsillectomy) in children in a private hospital setting in a developing country.
Methodology: This is a 30-month (January 2008 April, 2010) retrospective review of adenoid and tonsillar surgeries carried out in a private ENT surgical centre, in Jos, Nigeria. The biodata, investigation results of full blood count and electrolyte and urea, were retrieved and analyzed using Epi info version 2012.The result is presented in simple descriptive figures and tables.
Result: A total of 117 patients were seen in this hospital within the study period. Forty (34.2%) patients had benign tonsillar diseases. Thirty three (82.5%) were tonsillar hypertrophies with obstructive symptoms while the remaining seven (17.5%) were cases of recurrent tonsillitis. There were 25 males and 15 females giving an overall male to female ratio of 1.7:1. The youngest patient was 1 year while the oldest was 16 years.Ninety percent of the patients had normal pack cell volume (30 46%) while 10% had mild anaemia (PCV; 27 29%). About 97.5% had normal serum potassium level while one (2.5%) patient had mild hypokalaemia. Normal serum chloride and serum urea levels occurred in 80% of cases. All patients had normal white cell count with minor derangements in differential counts. Derangements in electrolytes and full blood count were generally mild and were not associated with complications encountered during surgery or postoperatively.
Conclusion: Routine electrolyte investigation and full blood count in children without risk factors such as history of vomiting and diarrhoea is not so necessary before tonsillar surgeries but we recommend that a pack cell volume be carried out in all patients. Few complications which were often not life threatening were noticed in our patients during surgery. These complications were unrelated to the pre-operative basic investigations.