Impact of Nurse-Led Versus Surgeon-Led Preoperative Counseling and Follow-Up on Postoperative Outcomes in Pediatric Tonsillectomy: A Longitudinal Observational Study.

Abstract

BACKGROUND Pre-tonsillectomy complex challenges in explaining surgeries requirements and preparing children for curative surgeries. In addition, post-tonsillectomy pain and complications are reported in children with tonsillitis. The objective of the study was to compare the intensities of postoperative pain and frequencies of postoperative complications among children undergoing elective tonsillectomy who received different types of counseling and follow-up care. MATERIAL AND METHODS Children received pre-tonsillectomy nurse-led counseling and post-tonsillectomy nurse-led follow-up care for 6 months (NCC cohort, n=29), pre-tonsillectomy surgeon-led counseling and post-tonsillectomy surgeon-led follow-up care for 6 moths (FSS cohort, n=35), or did not receive counseling and received everyday surgeons' visits during hospital stays only (UUS cohort, n=38). RESULTS Post-tonsillectomy pain was 4 (IQ range, 5-4) per child at discharge from the hospital. The children reported mild pain during the 1-month follow-up. Children in the NCC cohort had fever, post-tonsillectomy pain at discharge and 1 months after surgeries, needed less tramadol, had fewer hospital stays, had fewer immediate and late post-tonsillectomy complications (especially anxiety and vomiting), and had higher personal satisfaction and higher clinical benefits than children in the FSS and UUS cohorts (P<0.05). Nausea was reported in all children. A total of 56 (55%) children had a decrease in oral intake during the follow-up period. CONCLUSIONS Children may experience more post-tonsillectomy pain than expected at discharge and during follow-up. After tonsillectomy, children had a decrease in oral intake. Nurse-led counseling and follow-up care have favorable post-tonsillectomy outcomes and high personal satisfaction of children undergoing curative tonsillectomies.