TY - JOUR
T1 - Association of national guidelines with tonsillectomy perioperative care and outcomes
AU - Mahant, Sanjay
AU - Hall, Matt
AU - Ishman, Stacey L.
AU - Morse, Rustin
AU - Mittal, Vineeta
AU - Mussman, Grant M.
AU - Gold, Jessica
AU - Montalbano, Amanda
AU - Srivastava, Rajendu
AU - Wilson, Karen M.
AU - Shah, Samir S.
N1 - Publisher Copyright:
© 2015 by the American Academy of Pediatrics.
PY - 2015/7/1
Y1 - 2015/7/1
N2 - OBJECTIVE: To investigate the association of the 2011 American Academy of Otolaryngology Head and Neck Surgery guidelines with perioperative care processes and outcomes in children undergoing tonsillectomy. METHODS: We conducted a retrospective cohort study of otherwise healthy children undergoing tonsillectomy between January 2009 and January 2013 at 29 US children's hospitals participating in the Pediatric Health Information System. We measured evidence-based processes suggested by the guidelines (perioperative dexamethasone and no antibiotic use) and outcomes (30-day tonsillectomy complication-related revisits). We analyzed rates aggregated over the preguideline and postguideline periods and then by month over time by using interrupted time series. RESULTS: Of 111 813 children who underwent tonsillectomy, 54 043 and 57 770 did so in the preguideline and postguideline periods, respectively. Dexamethasone use increased from 74.6% to 77.4% (P,.001) in the preguideline to postguideline period, as did its rate of change in use (percentage change per month, 20.02% to 0.29%; P,.001). Antibiotic use decreased from 34.7% to 21.8% (P,.001), as did its rate of change in use (percentage change per month, 20.17% to 20.56%; P,.001). Revisits for bleeding remained stable; however, total revisits to the hospital for tonsillectomy complications increased from 8.2% to 9.0% (P,.001) because of an increase in revisits for pain. Hospital-level results were similar. CONCLUSIONS: The guidelines were associated with some improvement in evidence-based perioperative care processes but no improvement in outcomes. Dexamethasone use increased slightly, and antibiotic use decreased substantially. Revisits for tonsillectomy-related complications increased modestly over time because of revisits for pain.
AB - OBJECTIVE: To investigate the association of the 2011 American Academy of Otolaryngology Head and Neck Surgery guidelines with perioperative care processes and outcomes in children undergoing tonsillectomy. METHODS: We conducted a retrospective cohort study of otherwise healthy children undergoing tonsillectomy between January 2009 and January 2013 at 29 US children's hospitals participating in the Pediatric Health Information System. We measured evidence-based processes suggested by the guidelines (perioperative dexamethasone and no antibiotic use) and outcomes (30-day tonsillectomy complication-related revisits). We analyzed rates aggregated over the preguideline and postguideline periods and then by month over time by using interrupted time series. RESULTS: Of 111 813 children who underwent tonsillectomy, 54 043 and 57 770 did so in the preguideline and postguideline periods, respectively. Dexamethasone use increased from 74.6% to 77.4% (P,.001) in the preguideline to postguideline period, as did its rate of change in use (percentage change per month, 20.02% to 0.29%; P,.001). Antibiotic use decreased from 34.7% to 21.8% (P,.001), as did its rate of change in use (percentage change per month, 20.17% to 20.56%; P,.001). Revisits for bleeding remained stable; however, total revisits to the hospital for tonsillectomy complications increased from 8.2% to 9.0% (P,.001) because of an increase in revisits for pain. Hospital-level results were similar. CONCLUSIONS: The guidelines were associated with some improvement in evidence-based perioperative care processes but no improvement in outcomes. Dexamethasone use increased slightly, and antibiotic use decreased substantially. Revisits for tonsillectomy-related complications increased modestly over time because of revisits for pain.
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U2 - 10.1542/peds.2015-0127
DO - 10.1542/peds.2015-0127
M3 - Article
C2 - 26101361
AN - SCOPUS:84934269423
SN - 0031-4005
VL - 136
SP - 53
EP - 60
JO - Pediatrics
JF - Pediatrics
IS - 1
ER -