Audit of Day Case Tonsillectomy Aintree University Hospital, Liverpool M Baghat 1, S Knott 2, G Bessant 2, EZ Osman 2. 1:Faculty of Medicine, Alexandria University, Egypt 2: Department of ENT and Head and Neck Surgery, University Hospital Aintree, Background Day surgery is the admission of selected patients to hospital for a planned surgical procedure, returning home on the same day 1. The 2000 ‘NHS plan’ set a target of 75% of all surgical activity to be performed as such day case procedures 2. In 2006 we introduced a new service for adult ENT patients in Liverpool, with the intent of performing tonsillectomies as day case if possible. At present, all uncomplicated tonsillectomies are performed at Aintree with the intention of being day case procedures. Some of these cases are performed within the dedicated day case surgical unit, while the majority are performed within the main hospital site. The aim of this audit is to assess the Day Case Surgery tonsillectomy procedures provided at University Hospital Aintree (UHA) in line with the National Prospective Tonsillectomy Audit by the Royal College of Surgeons, England Methods Period under investigation: 01/01/ /12/2010 (12 months). The details of all patients who underwent tonsillectomy in 2010 were obtained from the audit and clinical coding departments. 217 patients were identified within the audit time frame in Aintree hospital. Patients’ electronic records were reviewed on the hospital Medway Sigma information system. 173 patients who underwent only bilateral tonsillectomy and not tonsillectomy as a part of another operation were included. We reviewed the case notes of all patients who had complications Data was analysed using Microsoft Excel spreadsheets. RESULTS Table showing readmission and complication rates following day-case tonsillectomies at Aintree Hospital main site and elective care day surgery unit. Discussion Day case tonsillectomies performed at Aintree are feasible and highly successful; 100% of patients with tonsillectomy performed at the day case surgical unit returned home on the same day with nil readmissions. Almost two-thirds of those procedures performed on the main hospital site returned home same day. We provide adult service only and this explain our high postoperative bleeding rate. In the national audit adults had higher bleeding rates 4.9% and return to theatre 1.2% Our readmission rate is higher than the results of the national audit and this reflect our policy of re-admitting patients with postoperative complications Recommendations Improvement of list planning at the main hospital site with tonsillectomies on the morning lists if possible. Modification of our anaesthetic protocol at the main hospital. Maximum pain control should be prescribed on discharge Prior to discharge, the surgeon should reinforce the written information provided regarding postoperative care and the importance of eating and drinking. UHADSUNational Audit Levels 3 No. of patients Gender (F:M)2.6:13:12.2:1 Complications rate14.5% (n 21)14.3%(n 4)N/A Re-admission rate11% (n16)0.0%3.9% Primary haemorrhage2% (n 3)0.0%0.6% Secondary haemorrhage4% (n6)0.0%3.0% Return to theatre2% (n 3)0.0%0.9% Blood transfusion0.0% 0.2% Effective day case rate59%100%12% UHA: Aintree main hospital site. DSU: Aintree Day Surgery Unit. British Association of Otorhinolaryngology- Head and Neck Surgery. ENT UK. FOUNDATION ENT AND HEAD AND NECK SURGERY CONFERENCE. March Royal College of Surgeons of England, London. References 1. Gandhimani, P. Jackson, I. UK Guidelines for day surgery. Surgery ;10; Department of health. The NHS plan: a plan for investment, a plan for reform. London, DH, National prospectus tonsillectomy, Audit by the Royal College of Surgeons, England % of tonsillectomy patients undergoing surgery at the elective care day case unit returned home the same day as their operation.