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.