Our experience with pre-operative haemostatic assessment of paediatric patients undergoing adenotonsillectomy at Federal Medical Centre, Makurdi

Background: In 2-4% of all patients requiring adenoidectomy, tonsillectomy or adenotonsillectomy, pre-operative screening tests for coagulation disorders are indicated to detect surgical bleeding complications. However, because of cost effect on the patients, the usefulness of these tests is being challenged. We therefore highlight our experience in paediatric patients undergoing adenoidectomy, tonsillectomy or both in our centre. Patients and Methods: This is a 3½-year analysis of the data of 165 paediatric patients who had adenoidectomy, tonsillectomy or both over the study period. The data collected included age, sex, procedure done and detailed clinical bleeding history. Results: A total of 165 children had either adenoidectomy or tonsillectomy, or both. There were 76 males and 89 females giving a male to female ratio of 1:1.2. Their ages ranged from 10 months to 18 years. Eighty-five (51.5%) patients had adenotonsillectomy, 48 (29.1%) and 32 (19.4%) had only tonsillectomies and adenoidectomies, respectively. Only 11 (6.7%) families volunteered the history of either prolonged bleeding with minor injury on the skin or occasional slight nose bleeding. Six (3.6%) patients including 3 of the children with positive family history had posttonsillectomy bleed, out of which 4 (66.7%) were moderate whereas the remaining 2 (33.3%) were severe bleeding, which was not statistically significant (P = 0.041). The two cases of severe bleeding had fresh whole blood transfused whereas the rest that had no bleeding issues were discharged home 48 h postoperatively. Conclusion: Our experience in this study suggests that detailed bleeding history is necessary as well as pre-operative haemostatic assessment, if available and affordable for paediatric patients undergoing adenotonsillectomy

Factors that contribute to prolonged hospital stay after discharge among surgical patients in a tertiary hospital in North Central Nigeria : Factors contributing to prolonged hospital stay after discharge

Background: Surgical practice has hospitalization of patients for surgery and treatment as an inherent part of it; after which the patients are found fit for discharge. There is however a group of patients who remain on bed even after they have been deemed fit for discharge. This study aimed to determine the number of days surgical patients classified as having prolonged stay remain in hospital after they were deemed fit for discharge and identify the reasons for this. Methods: Surgical patients still on bed more than 48 hours after they were discharged who consented to participate in the study were recruited. Results: A total of 341 patients were recruited. The mean duration of stay after discharge was 17.6± 13 days. The specialty with the highest number of patients was Neurosurgery. Lack of finance and absence of a caregiver were the causes (96.5% and 3.5% respectively). The top three suggestions by patients on how to reduce prolonged hospital stay were bill waiver for indigent patients, reduced cost of health care services and financial aid by philanthropists. Conclusion: The mean number of days patient remained in hospital after discharge was 17.6 days. Financial reasons and absence of a caregiver are the major reasons for prolonged hospital stay. There is a need for a multi-sectoral approach to improve enrollment in the National Health Insurance Scheme and provide social support for patients in need of care post-discharge to reduce the adverse effects of prolonged hospital stay on the hospital and patients