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Study Finds Tonsillectomy Care Varies among Children’s Hospitals

​More than half a million tonsillectomies are performed every year in children in the U.S., making the procedure the second most common reason for care in children's hospitals.

A study in the February 2014 Pediatrics, published online Jan. 20, found the quality of care of children after a tonsillectomy -- and how likely children are to return to the hospital for problems like bleeding, vomiting and dehydration after surgery -- varies significantly among hospitals.

The study, “Variation in Quality of Tonsillectomy Perioperative Care and Revisit Rates in Children's Hospitals,” tracked a retrospective cohort of low-risk children undergoing same-day tonsillectomy at 36 children's hospitals between 2004 and 2010.

The study was conducted in collaboration with the Center for Pediatric Clinical Effectiveness at the Children's Hospital of Philadelphia, through the Pediatric Research and Inpatient Setting Network (PRIS). It was funded by grants from the Children’s Hospital Association and the Pennsylvania Department of Public Health. Children with chronic complex diseases or who were admitted for emergency tonsillectomy were excluded. Researchers assessed the quality of care based on whether hospitals followed current practice guidelines that recommend dexamethasone (a corticosteroid used to reduce nausea, vomiting and pain) on the day of surgery, and no antibiotics. They also tracked how many patients returned to the hospital for problems within 30 days of surgery. Some hospitals provided almost no patients with the recommended dexamethasone and no antibiotics, compared with 91 percent at other hospitals. Of 139,715 children, 7.8 percent had a revisit to the hospital within 30 days, most commonly for bleeding (3 percent), and vomiting and dehydration (2.2 percent). In some hospitals, however, the revisit rate was 3 percent, compared to 12.6 percent in other hospitals. Older children, between 10 and 18 years of age, were at higher risk of returning to the hospital due to bleeding, and at lower risk of vomiting and dehydration, compared to children ages 1 to 2 years.

Study authors conclude that substantial variation exists in the quality of care for routine tonsillectomy in U.S children's hospitals. The data should be useful for hospitals’ tonsillectomy quality improvement efforts, according to the study authors.

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1/20/2014 12:00 AM