Impact of the pediatric tonsillectomy and polysomnography clinical practice guidelines.
OBJECTIVE
To evaluate the effect of the recently published guidelines on Tonsillectomy in Children and Polysomnography for Sleep-Disordered Breathing Prior to Tonsillectomy in Children on physician practice patterns.


METHODS
Cross-sectional survey.


METHODS
Survey of members of the American Academy of Otolaryngology-Head and Neck Surgery.


METHODS
Academic tertiary referral center.


RESULTS
A total of 280 physicians completed the survey, with a response rate of 41.7%. 93% of respondents had read the clinical practice guidelines. Many respondents had completed a pediatric otolaryngology fellowship (46%). A large group of physicians (46%) continue to prescribe antibiotics within 24h after surgery. One-third of respondents stopped prescribing antibiotics because of the guidelines. Discord between severity of symptoms and tonsil size was the most common reason cited for ordering a polysomnogram prior to tonsillectomy (76%). The most common reason cited for admission post-tonsillectomy was age less than 3 (40%). Less than half of physicians prescribe NSAIDs for pain control (43.8%) despite its safety profile, and only 23% reported that the guidelines influenced their use of NSAIDs postoperatively. Most respondents use intra-operative steroids (90%) as recommended.


CONCLUSIONS
The guidelines are intended to provide evidence based direction in tonsillectomy practices and improve referral patterns for polysomnography prior to tonsillectomy. The majority of the surveyed otolaryngologists reviewed these guidelines and some have changed their practice secondary to the guidelines. However, many physicians continue to prescribe post-operative antibiotics and do not use NSAIDs.
Division of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center College of Medicine, Hershey, PA, USA. Electronic address: dsetabutr@gmail.com.
Dhave
D
Setabutr
Division of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center College of Medicine, Hershey, PA, USA.
Eelam A
EA
Adil
Division of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center College of Medicine, Hershey, PA, USA.
Irina
I
Chaikhoutdinov
Division of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center College of Medicine, Hershey, PA, USA.
Michele M
MM
Carr
D000046:Academic Medical Centers; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010036:Otolaryngology / Q000592:standards; D010372:Pediatrics / Q000592:standards; D010414:Pennsylvania; D017286:Polysomnography / Q000379:methods / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians'; D011300:Preoperative Care / Q000379:methods; D011787:Quality of Health Care; D012017:Referral and Consultation; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology* / Q000517:prevention & control; D011795:Surveys and Questionnaires; D014068:Tonsillectomy / Q000592:standards* / Q000706:statistics & numerical data
Clinical practice guidelines; Obstructive sleep apnea; Pediatric otolaryngology; Polysomnography; Sleep-disordered breathing; Tonsillectomy