Ninety-day emergency department rebound following pediatric tonsillectomy: a retrospective cohort study

Gizelle Francis; Kalpesh Hathi; Jo Anne Douglas; Evan Nemeth; Paul Hong

doi:10.18203/issn.2454-5929.ijohns20261494

Authors

Gizelle Francis Department of Surgery, Division of Otolaryngology, Head and Neck Surgery, Dalhousie University, Halifax, NS, Canada
Kalpesh Hathi Department of Surgery, Division of Otolaryngology, Head and Neck Surgery, Dalhousie University, Halifax, NS, Canada
Jo Anne Douglas Department of Surgery, Dalhousie University, Halifax, NS, Canada
Evan Nemeth Performance and Analytics, Quality and System Performance, Nova Scotia Health, Halifax, NS, Canada
Paul Hong Department of Surgery, Division of Otolaryngology, Head and Neck Surgery, Dalhousie University, Halifax, NS, Canada

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20261494

Keywords:

Pediatric, Tonsillectomy, Complications, Pain, Bleeding, Emergency department, Rebound

Abstract

Background: Tonsillectomy is a very common pediatric surgical procedure. Post-operative complications such as hemorrhage, nausea, and dehydration frequently result in emergency department (ED) visits, leading to increased healthcare resource utilization. Understanding the patterns and predictors of post-tonsillectomy ED visits is crucial for developing strategies to improve care and reduce unnecessary healthcare burden.

Methods: A retrospective cohort study was conducted using administrative datasets to analyse province-wide ED visits within 90 days post-discharge following pediatric tonsillectomy. The study included all pediatric patients (<16 years) who underwent total or partial tonsillectomy at the pediatric health centre between April 1, 2016, and March 31, 2022. The first ED visit post-operation was categorized as either “surgical” or “medical” based on the presenting concern.

Results: A total of 702 ED visits from 527 unique patients were analyzed. The surgical ED rebound rate was 9.6%, with all surgical visits occurring within the first 30 days post-discharge. The most common reasons for surgical ED presentations were pain (20.3%), hemorrhage (14.0%), and nausea/vomiting (5.1%). Notably, 50.9% of surgical ED visits were classified as potentially preventable.

Conclusions: Post-tonsillectomy complications significantly contribute to pediatric ED visits, with pain and haemorrhage being the most frequent concerns. More than half of surgical ED visits did not require admission, suggesting that these visits could be mitigated through improved caregiver education, standardized analgesic regimens, and enhanced outpatient follow-up. Future interventions, including telemedicine, wearable monitoring, and AI-powered patient engagement tools, may reduce preventable ED utilization and optimize post-operative recovery.

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