Abstract

NM-358

A study on the efficacy and safety of combining dental surgery with tonsillectomy in pediatrics

Syed F, Uffman J, Tumin D, Flaitz C, Tobias J, Raman V
Nationwide Children's Hospital, Columbus, Ohio, USA

ABSTRACT
Introduction: In this study, we compared combined procedures to a cohort of patients undergoing multiple procedures under separate anesthetic encounters during a similar time period. Our hypothesis was that combining two procedures under a separate anesthetic would not result in increased perioperative complications or adversely impact outcomes.
Methods: We classified elective tonsillectomy ± adenoidectomy and restorative dentistry as combined (group C) or separate (group S). Outcomes included anesthesia time, recovery duration, the need for overnight hospital stay, and postoperative complications.
Results: Patients aged 4 ± 1 years underwent tonsillectomy and dental procedure in combination (n=7) or separately (n=27). No postoperative complications were noted. No difference was noted in total anesthesia time (C: 132 ± 34; S: 111 ± 24 minutes; p=0.060). Three of 7 patients in group C required PACU stay >60 minutes, compared to 22 of 27 patients in group S requiring prolonged PACU stay after one or both procedures (p=0.061). The need for overnight stay (C: 4 of 7, S: 20 of 27; p=0.394) did not differ between the groups. No postoperative complications were noted in either group.
Discussion: Combined procedures have been considered as a cost effective strategy to reduce the need for repeated hospitalization, missed days at school, missed work days for parents, and repeated exposure to anesthetic care. [1-3] However, the concern remains that the prolongation of anesthetic care to allow for combined procedures might be associated with an increased incidence of postoperative complications. Our preliminary data support the safety and efficacy of combining minor surgical procedures under the same anesthetic. We found that patients undergoing combined procedures, when compared to patients undergoing the same procedures under separate anesthetics had no difference in postoperative complications, the need for postoperative overnight admission, but did document a decreased incidence of a prolonged PACU stay.
Conclusion: Despite the logistic constraints of managing two separate surgical services, our preliminary data suggest that the combination of CRD and TA under a single anesthetic is feasible and safe.





References:
1. Balraj A, et al. Concurrent surgeries in ENT: a cost-effective and safe approach in patients requiring multiple definitive procedures. J Laryngol Otol 2004;118:31-33.
2. Stapleton M, et al. Combining procedures under general anesthesia. Pediatr Dent 2007;29:397-402.
3. Sinno S, et al. Assessing the safety and efficacy of combined abdominoplasty and gynecologic surgery. Ann Plast Surg 2011;67:272-274.