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Current Pediatric Tertiary Care Practices Following Adenotonsillectomy: An Update
Annie E Moroco1, Norman Friedman2, Christopher Jabbour3
1Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A.
The Laryngoscope
|December 11, 2023
Summary
Pediatric adenotonsillectomy practices vary widely, with most hospitals having admission policies but inconsistent guidelines for polysomnography and postoperative care. This highlights a need for a unified approach to perioperative management.
Area of Science:
- Pediatric Otolaryngology
- Healthcare Policy
- Surgical Practice Patterns
Background:
- Adenotonsillectomy is a common pediatric surgical procedure.
- Evolving societal guidelines influence practice patterns at academic centers.
- Variability exists in perioperative care for pediatric adenotonsillectomy.
Purpose of the Study:
- To assess current perioperative practice patterns for pediatric adenotonsillectomy at tertiary care children's hospitals.
- To identify variations in admission policies, polysomnography use, and postoperative monitoring.
- To evaluate adherence to updated clinical practice guidelines.
Main Methods:
- A cross-sectional survey of 70 pediatric otolaryngology division chiefs was conducted in July-August 2022.
- The survey assessed group practice patterns for children undergoing adenotonsillectomy.
- Data collection focused on admission criteria, polysomnography, and discharge protocols.
Main Results:
- A 46% survey response rate was achieved.
- Eighty-eight percent of groups have an official adenotonsillectomy admission policy, with age and obesity as common criteria.
- Significant variability exists in preoperative polysomnography (97% obtain) and postoperative observation (41% observe on room air).
Conclusions:
- Many children's hospitals have formal admission policies for adenotonsillectomy.
- Despite updated guidelines, substantial variation persists in preoperative polysomnography and postoperative monitoring/admission practices.
- An improved, unified approach to perioperative pediatric adenotonsillectomy care is warranted.
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