AAP study finds that quality of care varies for tonsillectomies

tonsillectomyIs your child going in for a tonsillectomy soon? Check out this recent study by the American Academy of Pediatrics, which assesses quality of care after a tonsillectomy and need for return visits to the hospital.

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

The study in the February 2014 Pediatrics, published online Jan. 20, found the quality of care of children after a tonsillectomy — and how likely they 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 group of low-risk children undergoing same-day tonsillectomy at 36 children's hospitals between 2004 and 2010.

Hospitals vary in following best practrices

Researchers assessed the quality of care based on whether hospitals followed current practice guidelines that recommend dexamethasone — a medicine used to reduce nausea, vomiting and pain — on the day of surgery, and not administering 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 anti nausea and pain medications and no antibiotics, compared with 91 percent at other hospitals.

Of 139,715 children in the study, 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, the study revealed.

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.