International Journal of Pediatric Otorhinolaryngology (2004) 68, 1367—1373 Daystaypediatrictonsillectomy–—asafe procedure NikkiMills a , BrianJ.Anderson b , ColinBarber a, * , JulianWhite a , MuraliMahadevan a , LeslieSalkeld a , GavinDouglas a , ColinBrown a a Department of Pediatric Otolaryngology, Auckland Children’s Hospital, Park Road, Auckland, New Zealand b Department of Anaesthesiology, University of Auckland, Park Road, Auckland, New Zealand Received 29 July 2003; received in revised form 27 March 2004; accepted 2 April 2004 KEYWORDS Tonsillectomy; Day surgery; Pediatric; Hemorrhage Summary Objective: There is a controversy about day stay pediatric tonsillectomy in the UK and Australia. New Zealand has a similar health structure and we wished to compare day stay tonsillectomy from our hospital with those reported from other centers. Methods: We performed a prospective audit of day stay tonsillectomy to determine conversion to hospital admission rate and the incidence of postoperative hemorrhage. Results: There were 4850 paediatric tonsillectomies performed with 80% of them as day stay procedures over a 9-year study period (1993—2002) in a university-affiliated tertiary children’s hospital. The primary postoperative hemorrhage rate (within 24h of surgery) was 0.9% (CI 0.68—1.22%) and 83% occurred within the mandatory 4h post- operative observation period. Primary hemorrhage requiring re-operation to achieve hemostasis occurred in 18 children (0.37%, CI 0.2—0.54%). No child with a primary hemorrhage who presented after discharge following day stay surgery required re- operation or blood transfusion. Day stay surgery was planned in 4041 children and 4.7% (CI 4.1—5.4%) required conversion to hospital admission. Postoperative vomiting was the most common indication for conversion (2.65%, CI 2.2—3.1%), while hemor- rhage contributed only 0.95% (CI 0.64—1.24%). Conclusions: This study was performed in a health system similar to that of Australia and the UK. Complication and conversion rates are similar to those reported in North American centers. Pediatric day stay tonsillectomy is a safe procedure when per- formed with strict preoperative criteria, trained day stay unit (DSU) staff, and with in-patient facilities on site. © 2004 Elsevier Ireland Ltd. All rights reserved. 1. Introduction The earliest description of tonsillectomy was in 30 AD by Cornelius Celsus who ‘‘tore’’ out the ton- sils and then painted the raw surface with vinegar * Corresponding author. Tel.: +64-9-3797440. E-mail address: colbar@xtra.co.nz (C. Barber). [1]. Celcus (25 BC—50 AD) reluctantly used opium and hyoscyamus for pain relief during surgery be- cause they were ‘‘bad for the stomach’’ (quoted in Collins [2], p. 4). These postoperative complica- tions of nausea and vomiting as well as postopera- tive bleeding persist despite vast improvements in surgical techniques and anesthesia. The first study describing tonsillectomy as a day stay procedure in adults was published in 1968 [3] but enthusi- 0165-5876/$ — see front matter © 2004 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijporl.2004.04.009