title: Variation in post-adenotonsillectomy admission practices in 24 pediatric hospitals.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  4.
authors.affiliation: Department of Plastic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Samita S
authors.initials: SS
authors.lastname: Goyal
authors.forename: Rahul
authors.initials: R
authors.lastname: Shah
authors.forename: David W
authors.initials: DW
authors.lastname: Roberson
authors.forename: Margot L
authors.initials: ML
authors.lastname: Schwartz
mesh_terms: D000233:Adenoidectomy; D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D016208:Databases, Factual; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D061214:Patient Safety; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology; D014068:Tonsillectomy
keywords: Practice variation; adenoidectomy; admissions; obstructive sleep apnea; patient safety; tonsillectomy