Wide variation exists in tonsillectomy care

It seems that wide variation exists between hospitals in the United States when it comes to tonsillectomy perioperative care for children.

Researchers from Toronto, Canada, as well as from a number of institutions across the United States, conducted a retrospective cohort study of approximately 140,000 low-risk children undergoing same-day tonsillectomy between 2004 and 2010 at 1 of 36 US children’s hospitals submitting data to the Pediatric Health Information System Database.

They found that some hospitals provided almost no patients with the currently recommended care of dexamethasone and no antibiotics, while other hospitals provided up to 91% of patients with those agents. Although many experts believe that dexamethasone reduces postoperative nausea and vomiting, it remains unclear whether antibiotics reduce posttonsillectomy morbidity.

In addition, the investigators found significant variation across hospitals in the total number of hospital revisits, the number of revisits for bleeding, and the number of revisits for vomiting and/or dehydration. Of the entire sample of children, 7.8% revisited the hospital within 30 days of surgery, most commonly for bleeding (3.0%), followed closely by vomiting and dehydration (2.2%). Older children (aged 10 to 18 years) were more likely than younger children (aged 1 to 3 years) to revisit the hospital for bleeding rather than for vomiting/dehydration.

However, the differences were notable. The number of hospital revisits ranged from 3.0% to 12.6%; the number of revisits because of bleeding ranged from 1.0% to 8.8%; and the number of revisits for vomiting/dehydration ranged from 0.3% to 4.4%.

The investigators conclude that more research is needed to determine the reasons for the substantial variations.

According to an American Academy of Otolaryngology Clinical Practice Guideline on the subject, tonsillectomy is one of the most common surgical procedures performed in the United States, with more than 530,000 procedures performed each year in children aged younger than 15 years.

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