title: Tonsillectomy Bleed Rates across the CHEER Practice Research Network: Pursuing Guideline Adherence and Quality Improvement.
abstract: (1) Compare postoperative bleeding in the CHEER network (Creating Healthcare Excellence through Education and Research) among age groups, diagnoses, and practice types. (2) Report the incidence of bleeding by individual CHEER practice site based on practice guidelines.
  
  
  
  Retrospective data collection database review of the CHEER network based on ICD-9 and CPT codes related to tonsillectomy patients.
  
  
  
  Multisite practice-based network.
  
  
  
  A total of 8347 subjects underwent tonsillectomy as determined by procedure code within the retrospective data collection database, and 107 had postoperative hemorrhage. These subjects had demographic information and related diagnoses based on the CPT and ICD-9 codes collected. Postoperative ICD-9 and CPT codes were used to identify patients who also had postoperative bleed. Variables included age (<12 vs ≥12 years), diagnoses (infectious vs noninfectious), and practice type (community vs academic). Statistical analysis included multivariate logistic regression variables predictive of postoperative bleeding, with P < .05 considered significant.
  
  
  
  Thirteen sites contributed data to the study (7 academic, 6 community). There was postoperative bleeding for an overall bleed rate of 1.3%. Patients ≥12 years old had a significantly increased bleed rate when compared with the younger group (odds ratio, 5.98; 95% confidence interval: 3.79-9.44; P < .0001). There was no significant difference in bleed rates when practices or diagnoses were compared.
  
  
  
  A site descriptor database built to expedite clinical research can be used for practice assessment and quality improvement. These data were also useful to identify patient risk factors for posttonsillectomy bleed.
authors.affiliation: Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA Section of Otolaryngology-Head and Neck Surgery, Durham VA Medical Center, Durham, North Carolina, USA walter.lee@duke.edu.
authors.forename: Walter T
authors.initials: WT
authors.lastname: Lee
authors.affiliation: Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Witsell
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA.
authors.forename: Kourosh
authors.initials: K
authors.lastname: Parham
authors.affiliation: Division of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Shin
authors.affiliation: Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Nikita
authors.initials: N
authors.lastname: Chapurin
authors.affiliation: Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Pynnonen
authors.affiliation: Northwest Hearing & Balance, University of Washington, Seattle, Washington, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Langman
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: Anh
authors.initials: A
authors.lastname: Nguyen-Huynh
authors.affiliation: Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Sheila E
authors.initials: SE
authors.lastname: Ryan
authors.affiliation: Department of Otolaryngology, Hofstra North Shore-LIJ School of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Vambutas
authors.affiliation: Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA.
authors.forename: Rhonda S
authors.initials: RS
authors.lastname: Roberts
authors.affiliation: Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Kris
authors.initials: K
authors.lastname: Schulz
mesh_terms: D016208:Databases, Factual; D005260:Female; D006302:Health Services Research; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D010036:Otolaryngology / Q000458:organization & administration; D019106:Postoperative Hemorrhage / Q000453:epidemiology*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014068:Tonsillectomy; D014481:United States
keywords: academic sites; community sites; guidelines; practice based network; tonsillectomy bleed rates; tonsillectomy complications