Introduction
Tonsillectomy is one of the most common surgeries in the field of otolaryngology. Annually more than 530,000 surgeries are performed on children younger than 15 years in the United States(1). Tonsillectomy is ranked second among pediatric outpatient surgeries and may have complications such as bleeding, pain and even death(2). Its mortality rate due to bleeding, airway obstruction or anesthesia complications is 1 in 15,000(3). Specifically, the rate mortality of post-tonsillectomy is about 2–4%. Studies show that approximately 1.3% of children experience prolonged hospitalization and delayed discharge after tonsillectomy. Besides, more than 3.9% of them require readmission due to secondary complications. The main reasons for prolonged hospitalization or readmission are complications such as post-tonsillectomy bleeding, fever, moderate to severe pain, and nausea(4). Also, ENT specialists often prefer to hospitalize the patient after tonsillectomy, considering the risk of tonsillectomy complications(5, 6).
Long-term hospitalization in addition to exposing the patient to a variety of nosocomial infections and psychological stress such as anxiety imposes heavy costs and threatens the individual’s mental and physical health(7, 8). Day case surgery has significantly grown within past two decades, following the development of short-term anesthesia and new methods(9). The term of day case surgery refers to surgery operation in hospital in day in which patients are prepared for scheduled, non-emergency surgical procedures and discharged within eight hours of surgery. Day case surgery was founded by Nickel (1864-1921)(10). In some countries such as Canada and the United States, day case surgery has increasingly become the norm for all patients undergoing elective surgery compared with inpatient surgery. It is performed for almost 90% of all surgery operations, but in many other countries it is less common (10). Day case surgery covers a wide range of surgical procedures from local anesthesia to general anesthesia(11). Applying day case surgeries can reduce treatment costs and saves the resources(7). However, it is important to recognize whether day case surgery can meet the patient needs or not due to the fact that not all patients can be treated by day case surgery(11, 12). Therefore, this study aimed to determine the most cost-effective method for patients by examining the cost and effectiveness aspects of day case surgery in comparison with inpatient surgery after tonsillectomy.