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Chippenham Hospital

Considerable Variation in Quality of Care for Tonsillectomy

Considerable Variation in Quality of Care for Tonsillectomy

Variation observed in dexamethasone, antibiotic administration and in revisit rates among children

MONDAY, Jan. 20, 2014 (HealthDay News) -- Considerable variation is observed across hospitals in the quality of care for routine tonsillectomy among children, according to a study published online Jan. 20 in Pediatrics.

In an effort to describe the quality of care at 36 U.S. children's hospitals, Sanjay Mahant, M.D., from the University of Toronto, and colleagues conducted a retrospective cohort study involving 139,715 low-risk children undergoing same-day tonsillectomy between 2004 and 2010.

The researchers found that 7.8 percent of the children had a 30-day revisit to the hospital. Across hospitals, significant variation was seen in the administration of dexamethasone (median, 76.2 percent; range, 0.3 to 98.8 percent) and antibiotics (median, 16.3 percent; range, 2.7 to 92.6 percent). Bleeding and vomiting and dehydration were the most common reasons for revisits (3.0 and 2.2 percent, respectively). The standardized risk of revisits for bleeding and for vomiting and dehydration were higher and lower, respectively, with older age (10 to 18 versus 1 to 3 years). Across hospitals, there was significant variability in total revisits (median, 7.8 percent; range 3.0 to 12.6 percent), revisits for bleeding (median, 3.0 percent; range 1.0 to 8.8 percent); and revisits for vomiting and dehydration (median, 1.9 percent; range 0.3 to 4.4 percent), after standardizing for differences in patients and year of surgery.

"These data on evidence-based processes and relevant patient outcomes should be useful for hospitals' tonsillectomy quality improvement efforts," the authors write.

One author disclosed financial ties to the CVS Medical Health Advisory Board.

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