Hospital and Surgeon Adherence to Pediatric Tonsillectomy Guidelines Regarding Perioperative Dexamethasone and Antibiotic Administration.
OBJECTIVE
To (1) determine adherence to American Academy of Otolaryngology-Head and Neck Surgery Foundation guidelines for pediatric tonsillectomy recommending routine administration of perioperative dexamethasone and against routine antibiotic administration among surgeons and hospitals in a multihospital network and (2) evaluate the impact of adherence on the risk of complications.


METHODS
Case series with chart review.


METHODS
Multihospital network.


METHODS
A case series of 15,950 children aged 1 to 18 years undergoing same-day surgery adenotonsillectomy (T&A) within a multihospital network from 2008 to 2014 was reviewed to determine whether dexamethasone and/or antibiotics were given in the hospital. The frequency of dexamethasone and antibiotic administration was compared among surgeons and hospitals in the years before and after the guidelines were published. The frequency of complications was compared in adhering vs nonadhering surgeons.


RESULTS
The study cohort included 15,950 children undergoing T&A at 19 hospitals by 74 surgeons. Of the patients before guideline publication, 98.4% (n = 7432) received dexamethasone compared with 98.9% of subjects after guideline publication (n = 8518). In total, 16.1% received antibiotics before the guidelines compared with 13.8% after. Prior to the guidelines, 27 of 74 surgeons (36%) routinely gave antibiotics. After the guidelines were published, 19 surgeons (26%) continued to give antibiotics more than 50% of the time. There was no difference in complication visits between adhering and nonadhering surgeons.


CONCLUSIONS
Most hospitals and surgeons administered perioperative dexamethasone routinely. While the overall frequency of antibiotic administration decreased after the guidelines were published, a significant percentage of surgeons continued to give antibiotics routinely, suggesting the need for improved dissemination and implementation of guidelines to promote adherence.
Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA.
Reema
R
Padia
Intermountain Healthcare, Surgical Services Clinical Program, Murray, Utah, USA.
Griffin
G
Olsen
Intermountain Healthcare, Surgical Services Clinical Program, Murray, Utah, USA.
Jake
J
Henrichsen
Intermountain Healthcare, Surgical Services Clinical Program, Murray, Utah, USA.
Griffin
G
Bullock
Intermountain Healthcare, Surgical Services Clinical Program, Murray, Utah, USA.
Craig
C
Gale
Department of Internal Medicine and Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, Utah, USA.
Gregory
G
Stoddard
Intermountain Healthcare, Surgical Services Clinical Program, Murray, Utah, USA.
Mark
M
Ott
Primary Children's Hospital, Intermountain Healthcare, Inc, Salt Lake City, Utah, USA Division of Pediatric Inpatient Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA.
Rajendu
R
Srivastava
Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA jeremy.meier@imail.org.
Jeremy D
JD
Meier
D000233:Adenoidectomy; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003907:Dexamethasone / Q000008:administration & dosage*; D013502:General Surgery; D019983:Guideline Adherence / Q000639:trends*; D006761:Hospitals; D006801:Humans; D007223:Infant; D010036:Otolaryngology; D019990:Perioperative Care / Q000592:standards*; D011183:Postoperative Complications / Q000517:prevention & control; D012955:Societies, Medical; D014068:Tonsillectomy
D000900:Anti-Bacterial Agents; D003907:Dexamethasone
surgeon adherence; tonsillectomy guidelines