Paediatric tonsillectomy and adenoidectomy clinical guidance: Discharge and recovery

This resource provides clinicians with guidance on planning post-procedure discharge and complication management for children having a tonsillectomy and/or adenoidectomy. It supports a patient and family-centred approach for safe home recovery of low-risk patients.

Treating surgeon actions

Determine the appropriateness of surgical intervention for the individual patient, based on:

• clinical judgement
• evidence-based criteria
• holistic assessment of risks and benefits
• examination of alternative treatment pathways.

Document the indications for the tonsillectomy on the request for admission form or if requested by the facility.

Assess the patient’s risk of post-operative or post-discharge complications prior to scheduling the procedure. Implement appropriate mitigation strategies in the preoperative phase to address any identified risks.

Document any explicit factors that puts the patient at high risk of post-operative complications.

Document post-operative care plan and escalation pathway in the event of clinical deterioration in discharge summary.

Ensure on-call ear nose and throat services are available for up to two weeks post-operation to manage post-tonsillectomy complications, including haemorrhage risk. If on-call ear nose and throat services are unavailable, access to a registrar who can provide advice and consultation is recommended. Use virtual care for routine follow ups where feasible. Tailor follow up based on local resource availability.

Consider the surgical service capabilities of the patient’s local hospital and the access to medical care post-discharge, including post-operation complications. Where appropriate, support local hospitals to deliver urgent care after discharge using a documented treatment and escalation pathway.

If the patient identifies as Aboriginal provide culturally appropriate support.

Support for Aboriginal patients

Initiate a conversation ("yarn") to discuss the pre-admission and post-operative care pathway, outlining the management plan to ensure the family is well-informed and supported throughout the process.

Coordinate care with the local Aboriginal health and social work teams, interpreter services, or other relevant staff. Ensure their involvement both before admission and post-operatively, particularly if complications occur.

Address the family’s socioeconomic and psychosocial needs, taking cultural factors into account when asking questions. Ensure that families understand these inquiries are meant to offer support, not to involve external agencies.

Maintain flexibility and sensitivity to Aboriginal healing practices through open communication with the entire health team. Ensure that risk management strategies and relevant management information are shared with all involved parties.

Aboriginal patients in regional hospitals

Establish clear management plans when access to a general practitioner is difficult or significant travel is involved to the nearest hospital.

Ensure families understand the complications that could arise.

Treating team actions: Patient information

Ensure any concerns about risks of post-operative complications have been communicated to the patient’s family or carers.

Provide comprehensive discharge instructions.

Encourage patients to seek advice from healthdirect (phone 1800 022 222) or their general practitioner if they have concerns about pain or bleeding after discharge.

Encourage the patient to go to their closest hospital emergency department if they need urgent attention after discharge, even if this is not where the procedure was performed.

Additional information for specific cohorts

Patients in metropolitan hospitals: Give metropolitan hospital patients a phone number to call should they have any concerns after discharge (clinical nurse consultant phone advice line).

Aboriginal patients: Provide information to link to the Aboriginal health team, social worker, interpreter services or other appropriate staff or teams prior to admission and post-operatively in the event of a post-operative complication.

Urgent medical attention after discharge

If a hospital is required to provide urgent and essential care outside their usual scope of surgical services for children, clinical governance requires local protocols be in place to facilitate consultation, escalation and transfer processes, as per the Paediatric Service Capability framework (GL2024_005).

This includes:

• formal networking arrangements
• admission, discharge and transfer criteria that reflect local and district service capabilities
• consideration of providing access to care as close to home as possible.

Evidence

These recommendations are based on the following evidence reviews:

• Post-tonsillectomy bleeding in children (PDF 234.1 KB)
• Post-tonsillectomy bleeding and pain evidence check (PDF 364.8 KB)