Tonsillectomy Essay

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Although the number of patients undergoing tonsillectomy has gradually declined since the 1970s, it remains one of the most common surgical procedures performed worldwide.1 The procedure, of course, is fairly routine—but not without risk. Mortality rates for the operation range from 1 in 10,000 to 1 in 35,000, with morbidity rates ranging from 1.5% to 14%; mortality and morbidity after tonsillectomy are usually the result of postoperative bleeding.2,3 In addition to bleeding, other common complications include pain, nausea, and vomiting. The patient’s surgeon plays a central role in minimizing risk. But as a primary care physician, you, too, play an important role in ensuring that your patient’s tonsillectomy is uneventful. This review will help toward that end. Address informed consent issues. While the surgeon is responsible for obtaining informed consent, a patient may discuss the procedure with you, the family physician. (See TABLE 1 for the indications for tonsillectomy.) Although the procedure is safe and effective, the patient and his or her family need to know that bleeding will most likely occur immediately after the procedure, although it can occur at any time during the first 2 weeks postop. Advise the patient and family that postop pain is similar to that of a throat infection, but is often felt in the ears (“referred otalgia”). Because postop swallowing is painful, the patient may not drink enough fluids. If this problem because severe, he or she may need to be admitted for IV fluid replacement. Discuss the patient’s length of stay. An increasing number of tonsillectomies are performed on an outpatient basis. However, high-risk patients—those with sleep apnea, coagulation disorders, or other underlying diseases, and anyone younger than 4 years of age or living a long distance from the hospital—should be admitted for overnight observation.4 Ask about

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