Tonsillectomy: Substantial Variability in Pediatric Hospital Care

MedicalResearch.com Interview with:
Dr. Sanjay Mahant, MD, FRCPC Division of Pediatric Medicine, Pediatric Outcomes Research Team (PORT), Department of Pediatrics, Institute of Health Policy, Evaluation and Management, University of Toronto, Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, CanadaDr. Sanjay Mahant, MD, FRCPC
Division of Pediatric Medicine, Pediatric Outcomes Research Team (PORT), Department of Pediatrics, Institute of Health Policy, Evaluation and Management, University of Toronto, Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Canada

MedicalResearch.com: What are the main findings of the study?

Dr. Mahant: In a large cohort of children undergoing same-day tonsillectomy at 36 children’s hospitals in the U.S., we observed substantial variability in several areas. These include: processes of care, the use of steroids and antibiotics – for which there are national guidelines that outline the recommended use of these medications – and outcomes of usage, as well as revisits to hospital after surgery for complications within 30 days following surgery.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Mahant: We were surprised at the degree of variation between hospitals in the use of medications (steroids and antibiotics) on the day of surgery, as well as the number of revisits to hospitals after the surgery for complications within the first 30 days. We expected to see some variation, but did not expect to see such a large range.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Mahant: For clinicians, our study highlights that complications after tonsillectomy that require a return visit to hospital are not uncommon. It also provides data on quality measurement and hospital revisit rates, which will be helpful for hospitals’ tonsillectomy quality improvement efforts.

Patients should take away that while tonsillectomy is a very common surgery in children, complications do occur and can be serious. Families should understand the goal of surgery and the potential complications for their child when making a decision about whether the child should undergo surgery.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Mahant: We need to understand factors that are important for reducing hospital revisits for complications following tonsillectomy. Studying high-performing hospitals may be important to elucidating these factors. Furthermore, quality improvement work is needed to implement current evidence of best practices into hospitals.

Citation:

Variation in Quality of Tonsillectomy Perioperative Care and Revisit Rates in Children’s Hospitals

Sanjay Mahant, Ron Keren, Russell Localio, Xianqun Luan, Lihai Song, Samir S. Shah, Joel S. Tieder, Karen M. Wilson, Lisa Elden, and Rajendu Srivastava, for the Pediatric Research in Inpatient Settings (PRIS) Network

Pediatrics peds.2013-1884; published ahead of print January 20, 2014, doi:10.1542/peds.2013-1884