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Safety of day-case paediatric tonsillectomy in England: an analysis of administrative data for the Getting It Right
W K Gray1, A S Takhar2, A V Navaratnam1
1Getting It Right First Time programme, NHS England and NHS Improvement, London, UK.
Insights
Same-day tonsillectomy discharge rates vary widely across UK Trusts. While not linked to worse outcomes overall, specialist centers should aim for higher day-case rates, over 70%, to reduce unwarranted variation.
Area of Science:
- Pediatric Surgery
- Health Services Research
- Quality Improvement
Background:
- Tonsillectomy is a common pediatric surgical procedure.
- Significant variation exists in day-case discharge rates following tonsillectomy across different hospital types.
- Understanding this variation and its impact on patient outcomes is crucial for optimizing care.
Purpose of the Study:
- To investigate unwarranted variation in same-day discharge rates after pediatric tonsillectomy.
- To examine the association between same-day discharge and adverse postoperative outcomes.
- To compare discharge rates and outcomes between specialist and non-specialist Trusts.
Main Methods:
- Analysis of the Hospital Episodes Statistics database for children (2-18 years) undergoing tonsillectomy (2014-2019).
- Stratification of Trusts into non-specialist (no pediatric critical care) and specialist (with pediatric critical care) categories.
- Adjusted analyses for patient demographics, presentation, and procedure type to assess re-admission rates and adverse outcomes.
Main Results:
- Same-day discharge rates varied significantly, from 5% to 100% in non-specialist Trusts and 9% to 88% in specialist Trusts.
- Same-day discharge was not associated with increased 30-day emergency re-admission at non-specialist Trusts, but showed a modest increase at specialist Trusts (OR 1.14).
- Adverse postoperative outcomes were similar between Trusts with high (>70%) and low (<50%) same-day discharge rates.
Conclusions:
- No consistent evidence suggests day-case tonsillectomy is associated with poorer outcomes.
- Specialist Trusts, in particular, should investigate low day-case rates.
- All Trusts should strive for same-day discharge rates exceeding 70% to minimize unwarranted variation.
Abstract:
We used the Hospital Episodes Statistics database to investigate unwarranted variation in the rates Trusts discharged children the same day after scheduled tonsillectomy and associations with adverse postoperative outcomes. We included children aged 2-18 years who underwent tonsillectomy between 1 April 2014 and 31 March 2019. We stratified analyses by category of Trust, non-specialist or specialist, defined as without or with paediatric critical care facilities, respectively. We adjusted analyses for age, sex, year of surgery and aspects of presentation and procedure type. Of 101,180 children who underwent tonsillectomy at non-specialist Trusts, 62,926 (62%) were discharged the same day, compared with 24,138/48,755 (50%) at specialist Trusts. The adjusted proportion of children discharged the same day as tonsillectomy ranged from 5% to 100% at non-specialist Trusts and 9% to 88% at specialist Trusts. Same-day discharge was not independently associated with an increased rate of 30-day emergency re-admission at non-specialist Trusts but was associated with a modest rate increase at specialist Trusts; adjusted probability 8.0% vs 7.7%, odds ratio (95%CI) 1.14 (1.05-1.24). Rates of adverse postoperative outcomes were similar for Trusts that discharged >70% children the same day as tonsillectomy compared with Trusts that discharged <50% children the same day, for both non-specialist and specialist Trust categories. We found no consistent evidence that day-case tonsillectomy is associated with poorer outcomes. All Trusts, but particularly specialist centres, should explore reasons for low day-case rates and should aim for rates >70%.
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