Although tonsillectomy is a common procedure and accepted practice guidelines are available, a recent study found "substantial variation" in perioperative tonsillectomy care provided by children’s hospitals in the U.S.
The American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) guidelines recommend perioperative administration of the corticosteroid dexamethasone to children undergoing tonsillectomy to reduce postoperative nausea, vomiting, and pain. Also, the guidelines do not recommend that clinicians routinely administer or prescribe perioperative antibiotics to children undergoing tonsillectomy.
The study published in Pediatrics involved several researchers from The Children's Hospital of Philadelphia who examined 139,715 tonsillectomy admissions for children ages 1 to 18 years across 36 children's hospitals between 2004 and 2012. The results showed 69.6 percent received dexamethasone, and 31.1 percent received antibiotics on the day of surgery.
The investigators also found that 7.8 percent of the study population - 10,868 children - revisited the hospital within 30 days of their procedure, with 36.5 percent of those being admitted and 63.5 percent, or 6,897 children, visiting the emergency department. Ninety-four percent of the revisits occurred within 15 days of surgery, and they were for bleeding, vomiting, and dehydration.
"Quality improvement initiatives are needed to implement current evidence into practice, understand and disseminate the practices of high-performing hospitals, and improve the value of health care delivered for children undergoing tonsillectomy," the authors wrote.
Sanjay Mahant, MD, MSc, FRCPC, of Toronto's Hospital for Sick Children, led the study. Children's Hospital's Ron Keren, MD, MPH, as well as the University of Pennsylvania's Russell Localio, PhD, also contributed to the investigation.