Hospital and Surgeon Adherence to Pediatric Tonsillectomy Guidelines Regarding Perioperative Dexamethasone and Antibiotic Administration

Objective To assess post-tonsillectomy hemorrhage (PTH), associated non-operative readmissions/revisits, and reoperations in children. Data Sources MEDLINE, EMBASE, and the Cochrane Library. Review Methods Two investigators independently screened studies against predetermined criteria and extracted key data. Investigators independently assessed study risk of bias and the strength of the evidence of the body of literature. We calculated unadjusted pooled estimates of PTH frequency and also conducted a Bayesian meta-analysis to estimate frequency of primary and secondary PTH and PTH-associated reoperation and revisits/readmissions by partial and total tonsillectomy and surgical approach. Results In meta-analysis, the frequency of primary and secondary PTH associated with total and partial tonsillectomy was below 4% for any technique and with overlapping confidence bounds. Pooled frequencies of PTH were also below 5% overall (4.2% for total tonsillectomy; 1.5% for partial tonsillectomy) in comparative studies. Fewer PTH occurred with tonsillectomy for obstructive sleep-disordered breathing than throat infection. In meta-analysis, frequency of PTH-associated non-operative revisits/readmission or reoperation ranged from 0.2% to 5.7% for total tonsillectomy and from 0.1% to 3.7% for partial tonsillectomy. At least four deaths were reported in case series including 1,778,342 children. Conclusions PTH occurred in roughly 4% of tonsillectomies in studies included in this review. Though studies typically did not report bleeding severity or amount, relatively few episodes of PTH necessitated reoperation for hemostasis. Nonetheless, tonsillectomy is not without risk of harm. Frequency of PTH across techniques was similar; thus we cannot conclude that a given technique is superior.

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“…We identified 46 unique database or registry studies or case series with ≥1000 children (reported in multiple papers) addressing PTH. 3,4,123-176…”

Section: Resultsmentioning

confidence: 99%

Postoperative Bleeding and Associated Utilization following Tonsillectomy in Children: A Systematic Review and Meta‐analysis

Francis

Fonnesbeck

Sathe

et al. 2017

Otolaryngol.--head neck surg.

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“…The first one is that a significant percentage of surgeons in the United States continued to use antibiotics routinely despite the guidelines [ 17 ]. The second issue is a small but considered significant increase in surgery for post-tonsillectomy bleeding following the publication of the guidelines [ 18 ]. The incidence of fever is the only concern in protocols that do not recommend the use of antibiotics, and in such incidences, they do give antibiotic [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Antibiotics for Post-Tonsillectomy Morbidity: Comparative Analysis of a Single Institutional Experience

et al. 2016

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BackgroundWe have conducted this study to evaluate the effect of antibiotics, whether oral or intravenous, compared to no antibiotic protocol on post-tonsillectomy morbidity.MethodsA total of 270 patients aged 3 - 12 years were included in the study. Patients were assigned into three groups randomly; each group consisted of 90 patients. In the first group (group A), patients were given intravenous injections of ceftriaxone 50 mg/kg/24 hours in divided doses, the second group (group B) received oral co-amoxiclav (dose according to weight) for 5 days post-operatively, and in the third group, patients were not given antibiotics. Patients were evaluated for the incidence of any bleeding, number of days before resuming normal diet, incidence of nausea and vomiting, incidence of abdominal pain, frequency of analgesic use in the first week, and pain.ResultsOur study groups were comparable in age, gender, and weight. There were no statistically significant differences between our study groups with regard to the incidence of post-tonsillectomy bleeding, time relapsed to resume normal diet, and pain score scale. Incidence of nausea, vomiting, and abdominal pain was more in the oral antibiotic group, and it was statistically significant.ConclusionWe do not recommend the routine use of antibiotics in post-tonsillectomy period in pediatric age group and oral antibiotics prove to have worse outcome with regard to the incidence of nausea, vomiting, and abdominal pain, and these recommendations need to be evaluated by multicenter evaluation.

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“…189 In addition, multiple studies have shown no significant change in pain, emergency room encounters, or hospitalization. 29,190-194…”

Section: Guideline Key Action Statementsmentioning

confidence: 99%

Clinical Practice Guideline: Tonsillectomy in Children (Update)

Mitchell

Archer

Ishman

et al. 2019

Otolaryngol.--head neck surg.

410

470

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Objective. This update of a 2011 guideline developed by the American Academy of Otolaryngology-Head and Neck Surgery Foundation provides evidence-based recommendations on the pre-, intra-, and postoperative care and management of children 1 to 18 years of age under consideration for tonsillectomy. Tonsillectomy is defined as a surgical procedure performed with or without adenoidectomy that completely removes the tonsil, including its capsule, by dissecting the peritonsillar space between the tonsil capsule and the muscular wall. Tonsillectomy is one of the most common surgical procedures in the United States, with 289,000 ambulatory procedures performed annually in children \15 years of age based on the most recent published data. This guideline is intended for all clinicians in any setting who interact with children who may be candidates for tonsillectomy. KAS 14 (Postoperative codeine), and KAS 15a (Outcome assessment for bleeding). (6) Addition of an algorithm outlining KASs. (7) Enhanced emphasis on patient and/or caregiver education and shared decision making.

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Hospital and Surgeon Adherence to Pediatric Tonsillectomy Guidelines Regarding Perioperative Dexamethasone and Antibiotic Administration

Cited by 22 publications

References 10 publications

Postoperative Bleeding and Associated Utilization following Tonsillectomy in Children: A Systematic Review and Meta‐analysis

Postoperative Bleeding and Associated Utilization following Tonsillectomy in Children: A Systematic Review and Meta‐analysis

Antibiotics for Post-Tonsillectomy Morbidity: Comparative Analysis of a Single Institutional Experience

Clinical Practice Guideline: Tonsillectomy in Children (Update)

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