Can tonsillectomy be effectively performed in a day care surgery setting in Sub-Saharan Africa? A cross sectional study

Background: Tonsillectomy, commonly performed for recurrent tonsillitis and obstructive sleep apnoea, is traditionally done in inpatient settings. However, ambulatory surgery is gaining popularity due to cost-effectiveness and faster recovery. In Sub-Saharan Africa, its feasibility remains underexplored. This study assessed eligibility criteria for ambulatory tonsillectomy in a Sub-Saharan country. Methodology: A cross-sectional study was conducted at Gyneco-Obstetric and Pediatric Hospital in Yaoundé, Cameroon, including patients undergoing tonsillectomy between January and September 2024. Eligibility for ambulatory surgery was based on preoperative factors such as age, comorbidities, and the ability to ensure post-operative care at home. Clinical and surgical data were extracted from records, while post-operative outcomes, including complications and recovery, were assessed within six hours after surgery. Results: Sixty patients (mean age: 4.5 years, range 3–6) underwent tonsillectomy for obstructive sleep apnoea. There were 22 females (36.7%). All patients were ASA1 (low surgical risk), and 96.7% (58) received intraoperative dexamethasone. No immediate complications were observed. At six hours post-surgery, pain was classified as light in 49 patients (81.7%) and mild in 11 (18.3%). Pain management included intravenous Paracetamol and niflumic acid suppository. Most patients (93.3%) resumed eating within six hours. Additionally, 90% (54) lived within an hour of the hospital, with responsible caregivers available. Parental satisfaction was high, with 78.3% (47) supporting same-day discharge, though 21.7% (13) had concerns about home monitoring. Conclusion: This study confirms that tonsillectomy can be safely performed in a day care setting in Sub-Saharan Africa for well-selected patients. Key eligibility factors include age, absence of comorbidities, and post-operative care capacity. Expanding ambulatory tonsillectomy in resource-limited settings could enhance healthcare efficiency and reduce costs. Keywords: Tonsillectomy, ambulatory surgery, eligibility criteria, Sub-Saharan Africa, post-operative outcomes, day care surgery.