Expanding the circle of care: Can children find a perioperative surgical home?

Excerpt

In this issue of the Journal, Murto et al. 1 describe analysis of a large surgical population of children up to age 18 yr (excluding newborns) in Ontario from 2002–2013. The primary focus is on adenotonsillectomy (AT), comprising almost one-third of surgeries, although data for the ten commonest childhood surgical procedures are also presented. The main finding of this study is the relative frequency of postoperative emergency room (ER) visits and hospital readmissions. For AT, the frequency of postoperative ER visits and hospital readmissions was 12.4% and 2.7%, respectively, mainly for nausea, vomiting, dehydration, or pain control. Adenotonsillectomy patients had the highest risk for urgent readmission of the entire cohort. Risk of readmission or ER visit was increased by prolonged hospital length of stay ≥ four days, associated comorbidities, and extremes of age (< three years or > 14 yr). The authors contend that management can be improved, and these adverse (and expensive) events can be diminished by more active perioperative interventions. …