Implementation of Tonsillectomy Guidelines in a Pediatric Otolaryngology Practice

Abstract

Objectives:

Describe the outcomes associated with following AAO-HNSF guidelines regarding cessation of routine antibiotics usage after tonsillectomy.

Methods:

A retrospective cohort study at a tertiary care stand-alone pediatric hospital of children who had a tonsillectomy performed by a single surgeon approximately 18 months before then after (January 2009 through August 2012) the release of American Academy of Otolaryngology—Head and Neck Foundation (AAO-HNSF) guidelines regarding tonsillectomy. The guidelines were fully implemented for antibiotic use by the surgeon who served as a self-control. Outcomes studied were secondary tonsil bleed rates, number of ER visits, readmissions, and parental calls. Descriptive statistics were applied for demographic data. Simple hypothesis testing, odds ratio, and relative risk calculations were done to determine outcomes.

Results:

1069 patients were included. 600 were exposed to antibiotics, and 469 were not. Average age was 7.1 years (range 1-20). 51% were male. Overall secondary bleed rate was 3.5%, ER visit rate was 10.3%, readmission rate was 5%, and the parental call rate was 21%. When comparing patients exposed to antibiotics to those who were not, there were no statistically significant differences in any of the outcomes measures.

Conclusions:

Eliminating routine antibiotics usage, as recommended by the guidelines, does not appear to adversely affect outcomes in post-tonsillectomy patients.