Guidelines to decrease unanticipated hospital admission following adenotonsillectomy in the pediatric population.
BACKGROUND
Tonsillectomy has become one of the most commonly performed surgical procedures in the pediatric-aged patient. Many of these children are diagnosed with obstructive sleep apnea (OSA). Although polysomnography is considered the gold standard, many practioners rely on the clinical examination and parental history. Nationwide Children's Hospital recently instituted pediatric adenotonsillectomy guidelines for hospital admission to help determine which patients should be done in main hospital OR vs. outpatient surgery facility. The main goal was to decrease unanticipated admissions. The secondary goal was to determine areas for practice improvement.


METHODS
Using databases for the hospital, operating room, and otolaryngology, all cases with CPT codes 42820, 42830, 42825, 42826, and 42821 were evaluated from October 2009 to August 2012 in the main operating room and 2 outpatient surgery centers. Data for each unanticipated admission were reviewed to determine whether the criteria were met according to the developed guidelines. Fisher's exact test was applied to the unplanned admission rate before and after the institution of the guidelines. Non-paired t-test and a Fisher's exact test were used for comparison of the demographic data between the two groups.


RESULTS
Following the institution of the pediatric adenotonsillectomy guidelines, the number of unanticipated admissions decreased from an absolute number of 88 to 43. This represents a decrease from 2.38% to 1.44% (p=0.008). Forty-two percent of the unanticipated admissions prior to establishing guidelines were in patients who would have met criteria for admission based on the guidelines. This decreased to 30% after establishing the guidelines.


CONCLUSIONS
We found that the institution of pediatric adenotonsillectomy guidelines for patients undergoing adenotonsillectomy significantly decreased the rate of unanticipated admission. However, there was still a significant percentage (30%) of unanticipated admissions due to non-compliance with the guidelines demonstrating the need for ongoing practice improvement.
Departments of Anesthesiology and Pain Medicine, Nationwide Children's Hospital and the Ohio State University, Columbus, OH, United States. Electronic address: Vidya.Raman@Nationwidechildrens.org.
Vidya T
VT
Raman
Department of Otolaryngology - Head & Neck Surgery, Nationwide Children's Hospital and the Ohio State University, Columbus, OH, United States.
Kris R
KR
Jatana
Department of Otolaryngology - Head & Neck Surgery, Nationwide Children's Hospital and the Ohio State University, Columbus, OH, United States.
Charles A
CA
Elmaraghy
Departments of Anesthesiology and Pain Medicine, Nationwide Children's Hospital and the Ohio State University, Columbus, OH, United States.
Joseph D
JD
Tobias
D000233:Adenoidectomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D017286:Polysomnography; D011183:Postoperative Complications; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000601:surgery*; D014068:Tonsillectomy / Q000009:adverse effects / Q000706:statistics & numerical data*
Adenotonsillectomy; Guidelines; Obstructive sleep apnea