Variation in post-adenotonsillectomy admission practices in 24 pediatric hospitals

Authors

  • Samita S. Goyal BS,

    1. Department of Plastic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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  • Rahul Shah MD,

    1. Division of Otolaryngology, Children's National Medical Center, Department Otolaryngology and Pediatrics, George Washington University School of Medicine, Washington, DC
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  • David W. Roberson MD,

    Corresponding author
    1. Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.
    • Department of Otolaryngology, Children's Hospital Boston, Boston, Massachusetts, U.S.A
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  • Margot L. Schwartz MPH

    1. Program for Health Care Quality and Outcomes, RTI International, Research Triangle Park, North Carolina
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  • The authors have no funding, financial relationships, or conflicts of interest to disclose.

Send correspondence to David W. Roberson, MD, Department of Otolaryngology, LO-367, Children's Hospital Boston, 300 Longwood Avenue, Boston MA 02115. E-mail: david.roberson@childrens.harvard.edu

Abstract

Objectives/Hypothesis

There is controversy about which children should be admitted after adenotonsillectomy (T&A) and limited clinical evidence to help with this decision. Current practice has evolved based on empirical or anecdotal evidence. We sought to identify practice variations in postoperative admission after T&A in tertiary care pediatric hospitals.

Study Design

Retrospective database study using administrative information stored in the Pediatric Health Information System (PHIS) database.

Methods

There were 29,920 T&As performed in 24 pediatric hospitals included in the PHIS database between July 1, 2009 and June 30, 2010. Patients were identified as outpatient (discharged the same day) or inpatient (not discharged on the day of surgery). We examined admission rates across different hospitals stratified by age, obstructive sleep apnea (OSA), and other complex chronic conditions.

Results

Younger age, the existence of a complex chronic condition, and OSA were all associated with higher post-T&A admission rates. Admission rates ranged from >94% for children under 2 years of age, with OSA and at least one medical comorbidity, to 14% for children older than 5 years, without OSA and without any medical comorbidities. Between-hospital variability was extreme; for example, for 3 to 5 year olds, the admission rate varied from 5% to 90% between hospitals. Very significant variation remained even after controlling for age, comorbidities, and OSA.

Conclusions

Post T&A admission rates vary tremendously across comparable tertiary-care pediatric hospitals. There is a crucial need for a better understanding of the risk of complications on the first postoperative night, and the appropriate indications for monitored admission on that night.

Level of Evidence

4. Laryngoscope, 123:2561–2567, 2013

Ancillary