Peri-operative management of high-risk paediatric adenotonsillectomy patients: A survey of 35 UK tertiary referral centres.
INTRODUCTION
Peri-operative management of high-risk paediatric patients undergoing adenotonsillectomy for treatment of obstructive sleep apnoea varies between tertiary referral hospitals. 'Day of surgery cancellation' (DoSC) rates of up to 11% have been reported due to pre-booked critical care being unavailable on the day of surgery as a result of competing needs from other hospital departments. We report the results of a survey of peri-operative management in UK tertiary care centres of high-risk paediatric patients undergoing adenotonsillectomy for obstructive sleep apnoea (OSA).


METHODS
An 8-point questionnaire was developed using a cloud-based software platform (www.surveymonkey.com). A web-link to the survey was embedded in a customised e-mail which was sent via secure server to the Clinical Leads for Paediatric Otolaryngology at 35 United Kingdom (UK) Tertiary referral centres.


RESULTS
The survey response rate was 60% (n = 21). Almost all (94.1%) of centres considered paediatric critical care facilities to be limited, with 70.6% (n = 12) stating that DoSC often occurred due to unavailable paediatric critical care capacity. There was variation between tertiary referral units in the practice applied for pre-booking critical care beds (our survey identifies 6 variations) (Table 1). The most frequent selection method reported (47.1%) was at the discretion of the booking clinician at the time of listing the patient for surgery.


CONCLUSION
In the context of limited critical care resources, variation in practice and difficulty in accurately predicting which patients will require post-operative critical care beds, a review and consensus on best practice in the peri-operative management of high risk paediatric adenotonsillectomy patients may offer a safe means of reducing cancellations and improving patient care, resource allocation and hospital efficiency.
['Cheong|Ryan Chin Taw|RC|', 'Bowles|Philippe|P|', 'Moore|Andrew|A|', 'Watts|Simon|S|']
D000233:Adenoidectomy D002648:Child D002675:Child, Preschool D006801:Humans D007223:Infant D019990:Perioperative Care D012017:Referral and Consultation D012306:Risk D020181:Sleep Apnea, Obstructive D011795:Surveys and Questionnaires D062606:Tertiary Care Centers D014068:Tonsillectomy D016896:Treatment Outcome D006113:United Kingdom
Peri-operative Paediatric Adenotonsillectomy Obstructive sleep apnoea Critical care