Admission practices following pediatric tonsillectomy: A survey of ASPO members

Abstract

Objectives: Although evidence-based Clinical Practice Guidelines (CPGs) have specified postoperative admission criteria for pediatric tonsillectomy, there is substantial variation in guideline implementation and adherence among otolaryngologists in practice. We aimed to assess pediatric otolaryngologists' post-tonsillectomy admission practices and to examine patient and surgeon factors associated with differences in admission practices.

Methods: An electronic cross-sectional survey was distributed to members of the American Society of Pediatric Otolaryngology (ASPO) to determine current practices regarding admission practices following pediatric tonsillectomy. Chi-square and Fisher's exact tests were performed to compare differences in adherence to tonsillectomy CPGs by respondent characteristics.

Results: The survey was sent to 644 pediatric otolaryngologists with a response rate of 19.1%. 37% of respondents reported "always" and 60% "often" using the Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) CPG to guide decision for admission. Years in practice was the factor most strongly associated with admission practices, with 10 or fewer years in practice significantly correlated with stricter adherence to the AAO-HNS CPG of overnight observation when Apnea-Hypopnea Index (AHI) ≥10, age <3 years, or O2 nadir <80%) (OR 4.2, p <0.001), as well as specific individual criteria such as an AHI ≥10 (OR 4.1, p = 0.03). Respondents in an academic practice setting were more likely to admit children <3 years of age than those in private practice (OR 5.0, p = 0.01).

Conclusion: Admission practices varied among pediatric otolaryngologist survey respondents, and strict AAO-HNS CPG adherence was associated with fewer years in practice and academic practice setting. These results suggest that further study investigating factors influencing guideline adherence and post-tonsillectomy admission practices is warranted.

Keywords: Adenotonsillectomy; Admission criteria; Child; Clinical practice guideline; Obstructive sleep apnea; Tonsillectomy.

Fig. 1.. Survey responses regarding admission criterion

Percentage of respondents that selected each criterion for which they observe children overnight following tonsillectomy. The guideline concordant option (Age <3 years, Apnea Hypopnea Index ≥10, O2 nadir <80%) is indicated in red (lighter shading in non-Web versions of the article).

Fig. 2.. Demographics of respondents according to AAO-HNS guideline adherence

Demographic analysis based on respondents indicating their application of American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) pediatric tonsillectomy guidelines in their practice.

Fig. 3.. Characteristics of respondents who strictly adhered to admission criteria

Characteristics of those who indicated strict adherence to the clinical practice guidelines, defined as those respondents who selected all three admission criteria of age <3 years, Apnea Hypopnea Index ≥10 and O2 nadir <80%.