Reducing Readmissions Post-tonsillectomy: A Quality Improvement Study on Intravenous Hydration.

Area of Science:

• Pediatric Surgery
• Quality Improvement Science
• Patient Safety

Background:

• Dehydration is a common and preventable complication following tonsillectomy.
• Post-tonsillectomy dehydration can lead to emergency department visits and hospital readmissions.
• Identifying risk factors and developing preventive interventions are crucial for improving patient outcomes.

Purpose of the Study:

• To identify risk factors associated with dehydration readmissions after tonsillectomy.
• To evaluate the effectiveness of increased intravenous (IV) hydration in preventing dehydration-related readmissions.
• To implement and assess a quality improvement initiative focused on post-tonsillectomy hydration.

Main Methods:

• Retrospective chart review of 11,157 pediatric patients (aged 1-18) undergoing tonsillectomy.
• Analysis of hospital readmission rates for dehydration within 72 hours of surgery.
• Interrupted time series analysis to assess the impact of increased IV fluid administration (1.5 times maintenance).

Main Results:

• A total of 96 patients (0.9%) experienced readmission for dehydration.
• The readmission rate decreased from 1% pre-implementation to 0.2% post-implementation, an 82% reduction.
• The hydration initiative demonstrated a statistically significant decrease in hospital readmissions.

Conclusions:

• Increased IV hydration post-tonsillectomy is an effective strategy for reducing dehydration readmissions.
• This intervention is safe, cost-effective, and easily implementable.
• Other institutions can consider adopting this approach to prevent post-tonsillectomy dehydration.