Objective

To examine the effect of postoperative steroid dosage on postoperative telephone calls, emergency department (ED) visits, and hemorrhage rates for two groups receiving different steroid dosing following radiofrequency ablation tonsillectomy.

Study design

Retrospective chart review between January 1, 2014 and January 1, 2019.

Setting

Tertiary care pediatric hospital.

Methods

Two postoperative steroid dosing protocols studied: 1) three postoperative doses of 0.5 mg/kg dexamethasone, or 2) three postoperative doses of 4 mg dexamethasone. Otherwise, postoperative care and pain control were similar for all patients. We hypothesized that standardized steroid dosing would achieve similar postoperative outcomes when compared to weight-based dosing with regards to patient phone calls, ED visits, readmission rates, and bleeding rates.

Results

Overall, 279 patients were included (n = 100 at 4 mg, n = 179 at 0.5 mg/kg). There were no differences between groups in age, gender, race, BMI, or comorbidities (P > 0.05). Readmission and ED visit rates were 2.8% and 12.2% respectively, with no significant difference between groups (P > 0.05)). The overall hemorrhage rate was 6.3%, including those patients presenting to the ED but not requiring intervention for bleeding concerns. There was no difference in hemorrhage rates between groups (P = 0.22); the hemorrhage rate requiring operative intervention was 1.4% with no difference between groups (P = 0.27). Postoperative phone calls to physicians’ office occurred in 13.3% of cases with no difference between groups (P = 0.41).

Conclusion

Comparable rates of readmission, ED visits, hemorrhage, and patient phone calls were seen with a standard dose of 4 mg versus 0.5 mg/kg weight-based dosing of a short course of postoperative dexamethasone following radiofrequency ablation tonsillectomy.

中文翻译：

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术后类固醇剂量对射频消融扁桃体切除术后再入院率的影响

客观的

检查术后类固醇剂量对射频消融扁桃体切除术后接受不同类固醇剂量的两组的术后电话、急诊科 (ED) 就诊和出血率的影响。

学习规划

2014 年 1 月 1 日至 2019 年 1 月 1 日期间的回顾性图表审查。

环境

三级护理儿科医院。

方法

研究了两种术后类固醇给药方案：1) 术后三剂 0.5 毫克/千克地塞米松，或 2) 术后三剂 4 毫克地塞米松。除此之外，所有患者的术后护理和疼痛控制都相似。我们假设，与基于体重的给药相比，标准化的类固醇给药在患者电话、急诊就诊、再入院率和出血率方面将获得相似的术后结果。

结果

总体而言，包括 279 名患者（n = 100 在 4 mg，n = 179 在 0.5 mg/kg）。各组间在年龄、性别、种族、BMI 或合并症方面无差异（P  > 0.05）。再入院率和急诊就诊率分别为 2.8% 和 12.2%，组间无显着差异（P  > 0.05））。总出血率为 6.3%，包括那些就诊于 ED 但不需要因出血问题进行干预的患者。组间出血率无差异（P  =0.22）；需要手术干预的出血率为 1.4%，组间无差异（P  = 0.27）。13.3% 的病例术后致电医生办公室，两组间无差异（P = 0.41）。

结论

在射频消融扁桃体切除术后短期服用地塞米松的标准剂量为 4 mg 与 0.5 mg/kg 体重相比，再入院率、急诊就诊率、出血率和患者电话率相当。