Variation in quality of tonsillectomy perioperative care and revisit rates in children's hospitals.
OBJECTIVE
To describe the quality of care for routine tonsillectomy at US children's hospitals.


METHODS
We conducted a retrospective cohort study of low-risk children undergoing same-day tonsillectomy between 2004 and 2010 at 36 US children's hospitals that submit data to the Pediatric Health Information System Database. We assessed quality of care by measuring evidence-based processes suggested by national guidelines, perioperative dexamethasone and no antibiotic use, and outcomes, 30-day tonsillectomy-related revisits to hospital.


RESULTS
Of 139,715 children who underwent same-day tonsillectomy, 10,868 (7.8%) had a 30-day revisit to hospital. There was significant variability in the administration of dexamethasone (median 76.2%, range 0.3%-98.8%) and antibiotics (median 16.3%, range 2.7%-92.6%) across hospitals. The most common reasons for revisits were bleeding (3.0%) and vomiting and dehydration (2.2%). Older age (10-18 vs 1-3 years) was associated with a greater standardized risk of revisits for bleeding and a lower standardized risk of revisits for vomiting and dehydration. After standardizing for differences in patients and year of surgery, there was significant variability (P < .001) across hospitals in total revisits (median 7.8%, range 3.0%-12.6%), revisits for bleeding (median 3.0%, range 1.0%-8.8%), and revisits for vomiting and dehydration (median 1.9%, range 0.3%-4.4%).


CONCLUSIONS
Substantial variation exists in the quality of care for routine tonsillectomy across US children's hospitals as measured by perioperative dexamethasone and antibiotic use and revisits to hospital. These data on evidence-based processes and relevant patient outcomes should be useful for hospitals' tonsillectomy quality improvement efforts.
Division of Pediatric Medicine, Pediatric Outcomes Research Team (PORT), Department of Pediatrics, Institute of Health Policy, Evaluation and Management, University of Toronto, Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Canada;
Sanjay
S
Mahant
Ron
R
Keren
Russell
R
Localio
Xianqun
X
Luan
Lihai
L
Song
Samir S
SS
Shah
Joel S
JS
Tieder
Karen M
KM
Wilson
Lisa
L
Elden
Rajendu
R
Srivastava
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000932:Antiemetics / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003907:Dexamethasone / Q000627:therapeutic use; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D019990:Perioperative Care / Q000592:standards*; D011183:Postoperative Complications / Q000453:epidemiology; D011787:Quality of Health Care; D012189:Retrospective Studies; D014068:Tonsillectomy
D000900:Anti-Bacterial Agents; D000932:Antiemetics; D003907:Dexamethasone
antibiotics; children’s hospitals; dexamethasone; perioperative; quality of care; readmissions; regional variation; tonsillectomy