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Impact of the pediatric tonsillectomy and polysomnography clinical practice guidelines
Dhave Setabutr1, Eelam A Adil1, Irina Chaikhoutdinov1
1Division of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center College of Medicine, Hershey, PA, USA.
Insights
New guidelines for pediatric tonsillectomy and polysomnography have been reviewed by most otolaryngologists. While some practice changes occurred, many physicians still prescribe post-tonsillectomy antibiotics and underutilize NSAIDs.
Area of Science:
- Otolaryngology
- Pediatric Sleep Medicine
- Clinical Practice Guidelines
Background:
- Clinical practice guidelines for pediatric tonsillectomy and polysomnography were recently published.
- These guidelines aim to standardize care and improve outcomes for children with sleep-disordered breathing.
Purpose of the Study:
- To assess the impact of new guidelines on physician practice patterns regarding tonsillectomy and polysomnography.
- To identify adherence and areas for improvement in current otolaryngology practices.
Main Methods:
- A cross-sectional survey was conducted among members of the American Academy of Otolaryngology-Head and Neck Surgery.
- Data were collected from physicians at an academic tertiary referral center.
Main Results:
- 93% of surveyed physicians had read the guidelines, and one-third altered antibiotic prescribing post-guidelines.
- Despite guidelines, 46% continued post-operative antibiotics, and only 43.8% prescribed NSAIDs for pain.
- Polysomnography ordering was primarily driven by symptom severity and tonsil size discordance (76%).
Conclusions:
- The published guidelines have been widely reviewed by otolaryngologists, influencing some practice changes.
- Continued prescribing of post-operative antibiotics and underutilization of NSAIDs highlight areas needing further attention.
- Adherence to guidelines for polysomnography referral and pain management requires further improvement.
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.
Study Design:
Cross-sectional survey.
Method:
Survey of members of the American Academy of Otolaryngology-Head and Neck Surgery.
Setting:
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.
Conclusion:
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.
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