Review

A review of a journal article created by a Journal Watch contributor

Parents' perspective on recovery at home following adenotonsillectomy

A prospective single-centre qualitative analysis

Canadian Journal of Anaesthesia

Submitted September 2023 by Dr Patrick Cowie

Read by 150 Journal Watch subscribers

Summary:
This article explores parental experiences following paediatric adenotonsillectomy. The authors recruited parents of children having adenotonsillectomy over a year-long period at Montreal’s Children Hospital, Canada. The authors investigated what problems parents faced, what strategies they used to care for their child and what support was provided. The information was collected in a postoperative diary in either English or French. Return to hospital rate and reasons for re-admission were also recorded.

There is a well-presented flowchart showing recruitment and outcome. The annual caseload of patients between the ages of 2 and 12 adenotonsillectomy was 563, patients with significant co-morbidities were excluded. Of these, 355 parents were approached and 324 consented, leading to a study population of 317 parents. 63 were uncontactable after discharge, and 145 of the remaining 254 parents actually made comments in their postoperative diary. This showed 46% of parents (n = 145) completed comments in their diary. This is a reasonably large sample size and retention rate for a qualitative study.

Significant postoperative pain was not surprisingly the main issue encountered by parents, occurring in just over half of the patients. Other major issues were sleep disruption and poor oral intake including refusal of medications. Very few parents commented on significant PONV. Interesting issues included the discomfort caused by oral medications, even in liquid form, which made administration challenging. To help their children, parents used a combination of pharmacological strategies (there was no standard analgesic regime) and non-pharmacological strategies, such as distraction, cold foods or liquids. The use of morphine to promote sleep was a noteworthy finding, especially given the potential for opioid sensitivity in children with sleep disordered breathing or unquantified OSA. Of those parents who made comments in their diaries, 12% required to return to hospital – more for dehydration/ poor oral intake than for post-tonsillectomy haemorrhages. Interestingly, this figure was less than the return to hospital rates for parents who did not complete their diaries. The authors felt that completion of the diary and support of using pain scales made have been advantageous for these families.

Take home messages/commentary:
This article continues to reinforce the significant burden on parents or carers following adenotonsillectomy. It suggests that having structured pain scores and support may reduce return to hospital rates. The article is generalisable, presenting a paediatric common operation and achieving a relatively large study size. Limitations include the qualitative nature of the study, which makes any finding dependent on parental opinion and the authors’ interpretation of these, and the lack of a standard post-tonsillectomy analgesic regime now present in many hospitals.

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