Pediatric tonsillectomy: clinical practice guidelines.

OBJECTIVE This article presents the Clinical Practice Guidelines for Pediatric Tonsillectomy of the French Society of ENT and Head and Neck Surgery (SFORL), entitled "Amygdalectomie de l'enfant : Recommandation pour la pratique clinique" (SFORL, 2009). METHOD The French Society of ENT (SFORL), in partnership with the French Association for Ambulatory Surgery (AFCA) and French Society for Anaesthesia and Intensive Care (SFAR), set up a representative panel in the fields of anesthesiology, ENT and head-and-neck surgery, pediatrics, sleep medicine and general medicine. Following the literature analysis reported in the Presentation of the Guidelines, recommendations were drawn up taking account of risk/benefit ratios, levels of evidence, feasibility in pediatric tonsillectomy and baseline risk assessment in the relevant population. RESULTS Around 50,000 pediatric tonsillectomies, with or without associated adenoidectomy, are performed in France each year. Postoperative morbidity and mortality are non-negligible, despite progress in peri-operative management. The present guidelines address the following questions: 1) What are the indications for tonsillectomy, notably in case of obstructive sleep disorder; 2) What pre-operative assessment is required? 3) What are the technical principles involved? 4) What are the selection criteria for ambulatory tonsillectomy? 5) How should postoperative follow-up be organized? 6) How should complications be managed? CONCLUSION The present Clinical Practice Guidelines for pediatric tonsillectomy in France should improve clinical and organizational practices to enhance patient safety. They seek to ensure optimal conditions of care for all children undergoing tonsillectomy.