Tonsillectomy care for children differs by hospital
Though parents might expect their children to receive consistent care across hospitals in the US for routine procedures, a new study published in the journal Pediatrics investigates how quality of care for children after a tonsillectomy varies from hospital to hospital.
The study authors worked in collaboration with the Center for Pediatric Clinical Effectiveness at the Children's Hospital of Philadelphia, PA, and the Pediatric Research and Inpatient Setting Network (PRIS).
Over 500,000 tonsillectomies are performed on children in the US each year, the researchers say, which makes it the second most common reason for care in children's hospitals.
But they wanted to determine whether this routine procedure was, well, routine across all hospitals.
So they retrospectively tracked low-risk children who underwent same-day tonsillectomies between 2004 and 2010 at 36 children's hospitals. They excluded children with chronic diseases or those who were admitted to the hospital for an emergency tonsillectomy.
Quality of care was evaluated by noting whether or not hospitals followed the current practice guidelines, which advise using dexamethasone - a corticosteroid that reduces nausea, vomiting and pain - and not using antibiotics.
Variations found in adherence to guidelines
The team traced how many children returned to the hospital within 30 days of their surgery with problems such as bleeding, vomiting and dehydration.
The study found that hospital revisit rates for children who underwent tonsillectomies varied from 3% in some hospitals to over 12% in others, revealing inconsistencies in quality of care.
Though some hospitals provided 91% of their patients with the recommended dexamethasone and no antibiotics, others provided almost no patients with this kind of care.
On average, 7.8% of the children in the study returned to the hospital within 30 days. Of these, 3% returned for bleeding, while 2.2% returned for vomiting and dehydration.
However, the researchers found that in some hospitals, the revisit rate was only 3%, compared with 12.6% in other hospitals.
They also found that children between the ages of 10 and 18 had a higher risk of returning due to bleeding and a lower risk for vomiting and dehydration, compared with children between the ages of 1 and 2.
The authors conclude their study by writing:
"Substantial variation exists in the quality of care for routine tonsillectomy across US children's hospitals as measured by perioperative dexamethasone and antibiotic use and revisits to hospital."
"These data on evidence-based processes and relevant patient outcomes should be useful for hospitals' tonsillectomy quality improvement efforts," they add.
Another popular children's procedure involves ear surgery for tympanostomy tubes - tiny plastic devices placed in the eardrum to treat persistent ear infections or enduring middle ear fluid.
In 2013, a multidisciplinary panel offered clear recommendations for whether infants and kids would benefit from the surgery or not.
Written by Marie Ellis
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