Is Daycare Tonsillectomy Safe?

Document Type: Original


Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.


Tonsillectomy is one of the most common procedures performed by Ear, Nose, and Throat surgeon.  Usually, the procedure is carried out as an inpatient surgery. With the increasing need to reduce healthcare costs, spare precious hospital beds, and shorten elective surgery lists, there is currently a trend towards performing tonsillectomy on a daycare basis.
 Materials and Methods:
A prospective review of all tonsillectomies performed at the University Malaya Medical Center was undertaken for the year 2013. Demographic details, qualifying indications, and complication rates were evaluated.
There was no incidence of primary hemorrhage among the 96 tonsillectomies performed. There was no significant correlation in terms of secondary hemorrhage between inpatient and day-case tonsillectomy (P=0.54). Only two patients required revision surgery to stop post-tonsillectomy bleeding. None of the patients required blood transfusion, and there were no mortalities.
Daycare tonsillectomy is safe as long as the patient is carefully selected. Both medical and social aspects should be taken into consideration. A post-operative observation period of at least 6 to 8 hours is important. The surgeon should personally review the patient post-operatively and decides if he or she should be hospitalized for observation, or safe for discharge.


Main Subjects

1. Carithers JS, Gebhart DE, Williams JA. Postoperative risks of pediatric tonsilloadeno- idectomy. The Laryngoscope 1987; 97(4): 422–9.

2. Fujihara K, Koltai PJ, Hayashi M, Tamura S, Yamanaka N. Cost-effectiveness of tonsillectomy for recurrent acute tonsillitis. Ann Otol Rhinol Laryngol 2006; 115(5):365–9.

3. Paradise JL, Bluestone CD, Colbom DK, Bernard BS, Rockette HE, Kiirs-Lasky M. Tonsillectomy and adenolonsillectomy for recurrent throat infection in moderately affected children. Pediatrics 2002;110(1):7–15.

4.  Pickering AE, Bridge HS, Nolan J, Stoddart PA. Double blind, placebo-controlled analgesic study of ibuprofen or rofecoxib in combination with paracetamol for tonsillectomy in children.Br J Anaesth 2002; 88(1):72–7.

5. Raymond CA. Study Questions Safety Economic Benefits of Outpatient Tonsil/Adenoid Surgery. JAMA1986; 256(3):311–2.

6. Reiner SA, Sawyer WP, Clark KF, Wood MW. Safety of outpatient tonsillectomy and adenoidectomy. Otolaryngol Head Neck Surg 1990; 102(2):161–8.

7. Maniglia AJ, Kushner H, Cozzi L. Adenotonsillectomy-A Safe Outpatient Procedure. Arch Otolaryngol Head Neck Surg.1989;115(1):92–4.

8. Guida RA, Mattucci KF. Tonsillectomy and Adenoidectomy: An Inpatient or Outpatient Procedure. Laryngoscope.1990; 100(5):491–493.

9. Tewary AK. Day-case tonsillectomy: a review of the literature. J Laryngol Otol. 1993; 107(8):703–5.

10. Laureyns G, Lemkens P, Jorissen M. Tonsillectomy as a day-case surgery: a safe procedure? B-ENT. 2006; 2(3):109–16.

11. Nurliza I, Norzi G, Azlina A, Hashimah I, Sabzah MH. Daycare tonsillectomy: a safe outpatient procedure. Hospital Sultanah Bahiyah, Alor Setar Malaysia experience. Med J Malaysia. 2011;66(5): 474–8.

12. Bluestone CD. Status of tonsillectomy and adenoidectomy. Laryngoscope. 1977; 87(8):1233–43.

13. Ranjit S, Brett RH, Lu PK, Aw CY. The incidence and management of post-tonsillectomy haemorrhage:
a Singaporean experience. Singapore Med J 1999; 40(l0):622–6.

14. Ahmad R, Abdullah K, Amin Z, Rahman JA. Predicting safe tonsillectomy for ambulatory surgery. Auris Nasus Larynx. 2010;37(2):185–9.

15. Chee NW, Chan KO. Clinical audit on tonsils and adenoid surgery. Is day surgery a reasonable option. Ann Acad Med Singapore 1996; 25:245–50.

16. Postma DS, Folsom F. The case of outpatient "approach" for all pediatric tonsillectomies and/or adenoidectomies: a 4-year review of 1419 cases at a community hospital. Otolaryngol Head Neck Surg 2002;127:101–8.

17. Ross AT, Kazahaja K, Tom LW. Revisiting outpatient tonsillectomy in young children. Otolaryngol Head Neck Surg 2003;128(3):326–31.

18. Granell J, Gete P, Villagruela M, Bolanos C, Vicent JJ. Safety of outpatient tonsillectomy in children: a review of 6 years in a tertiary hospital experience. Otolaryngol Head Neck Surg 2004; 131:383–7.

19. Masoom A, Akhtar S, Humayun HN, Ikram M. Daycare adeno-tonsillectomy: is it safe in developing countries? J Pak Med Assoc. 2012; 62:458–60.

20. Tewary AK. Day-case tonsillectomy: A review of the literature. J Laryngol Otol 1993; 107:703–5.

21. Gabalski EC, Mattucci KF, Setzen M, Moleski P. Ambulatory tonsillectomy and adenoidectomy. Laryngoscope. 1996; 106(1 Pt 1):77–80.

22. Moralee SJ, Murray JA. Would day-case adult tonsillectomy be safe? J Laryngol Otol. 1995;109 (12): 1166–7.

23. Bennett AMD, Clark AB, Bath AP, Montgomery PQ. Meta-analysis of the timing of haemorrhage after tonsillectomy: an important factor in determining the safety of performing tonsillectomy as a day case procedure. Clin Otolaryngol 2005; 30:418–23.