Why in hospital following transoral robotic lingual tonsillectomy?

Abstract

Background

The reported hospital length of stay (LOS) following transoral robotic surgery lingual tonsillectomy (TORS-L) is variable, with limited understanding of the factors requiring hospitalization and no evidence-based criteria for discharge.

Aims/objectives

This observational cohort study investigated factors hindering discharge following TORS-L in a well-defined postoperative care program.

Methods

Patients were included between August 2020 and October 2022. A discharge scheme was filled out twice daily, specifying the factor(s) for hospitalization among patients undergoing TORS-L. This trial was a sub-investigation of a national multicentre randomized clinical trial (RCT) testing the efficiency of high-dose dexamethasone on postoperative pain control. Participation in the RCT demanded admission to the fourth postoperative day as dexamethasone/placebo was given intravenously in repeated dosages till day 4 postoperatively.

Results

Eighteen patients were included in the analysis. The main factor for hospitalization was nutritional difficulties, while pain was a limiting factor for discharge only on the first postoperative 1-3 days. More than half of the patients could have potentially been discharged on postoperative day 2 when omitting the RCT treatment plan in the analysis.

Conclusion

The study estimates that the majority of patients may be discharged on postoperative day 2 following TORS-L.

Chinese Abstract

背景: 据报告, 经口机器人舌侧扁桃体切除术 (TORS-L)手术后的住院时间 (LOS) 的长短各不相同, 对需要住院治疗的因素了解有限, 并且缺乏基于证据的出院标准。

目的: 这项观察性队列研究调查了一项术后护理项目中的TORS-L后阻碍出院的因素。

方法: 纳入 2020 年 8 月至 2022 年 10 月期间的患者。每天填写两次出院方案, 具体说明接受 TORS-L 的患者的住院因素。 这试验是一项国家多中心随机临床试验(RCT)的子研究, 测试大剂量地塞米松对术后疼痛控制的效率。参与 随机临床试验要求

术后住院四天, 因为静脉注射地塞米松/安慰剂重复给药直至术后第4天。

结果: 18 名患者被纳入分析。 住院的主要原因是营养困难, 而疼痛仅在术后前一至三天成为出院的限制因素。当分析中忽略RCT治疗计划时, 超过一半的患者可能在术后第二天出院。

结论: 研究估计大多数患者可以在TORS-L术后第二天出院。

Keywords:

• Transoral robotic surgery
• hospitalization
• recovery

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was supported by a private non-profit foundation, Candys Foundation (Grant ID: 2019-304), Forskningspuljen mellem OUH og RH (Grand ID: A4723) and Region Hovedstadens Forskningsfond til Sundhedsforskning (Grant ID: A6682)