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Impact of Clinical Practice Guidelines on Pediatric Tonsillectomy for Tonsillitis
Avivah J Wang1, Jeffrey Cheng1
1Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA.
Insights
Updated guidelines for pediatric tonsillectomy significantly improved adherence to evidence-based practices. The study found fewer tonsillectomies were performed post-guideline release, suggesting improved quality of care for children with recurrent throat infections.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Health Services Research
Background:
- The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNSF) released updated Clinical Practice Guidelines (CPG) for tonsillectomy in children in 2019.
- Assessing the impact of these guidelines on clinical practice patterns is crucial for quality improvement.
Purpose of the Study:
- To evaluate the effect of the 2019 AAO-HNSF CPG for Tonsillectomy in Children on adherence to evidence-based practice.
- To determine if the guidelines influenced the rate of tonsillectomy procedures.
Main Methods:
- A retrospective chart review was conducted on patients aged 1-18 undergoing tonsillectomy for throat infections between 2015 and 2023.
- Patients with obstructive sleep-disordered breathing were excluded.
- Adherence to evidence-based practice was assessed by comparing pre- and post-guideline release data.
Main Results:
- Adherence to evidence-based practice significantly increased from 73.1% pre-CPG to 85.4% post-CPG (P=.0088).
- A trend towards improved adherence for pediatric tonsillectomy for recurrent infections was observed.
- Fewer tonsillectomies were performed post-CPG, despite an increase in total throat infection encounters.
Conclusions:
- The updated AAO-HNSF CPG for Tonsillectomy in Children coincided with improved adherence to evidence-based practice and a reduction in overall tonsillectomy rates.
- The CPG appears to be an effective tool for quality improvement, potentially reducing practice variation and patient harm.
- Further research should explore guideline dissemination in other specialties and the impact on quality of life for children managed non-surgically.
Objective:
To determine the impact of the release of updated American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNSF) Clinical Practice Guidelines (CPG) for Tonsillectomy in Children in 2019 on adherence to evidence-based practice.
Methods:
Patients between ages 1 and 18 who had tonsillectomies and encounters for throat infection (tonsillitis or pharyngitis) between of February 5, 2015 and February 4, 2023 were identified by International Classification of Diseases and Current Procedural Terminology codes, excluding those with obstructive sleep-disordered breathing. Retrospective chart review was performed to determine adherence to evidence-based practice.
Results:
There was a significant increase in adherence to evidence-based practice post-CPG release compared to pre-CPG (85.4% vs 73.1%, P = .0088). There was an observed trend for improved adherence to evidence-based practice for pediatric tonsillectomy for recurrent infection for most of the post-CPG period. There were fewer tonsillectomies performed post-CPG, despite more total encounters for throat infection.
Discussion:
The publication of the updated AAO-HNSF CPG corresponded with improved adherence to evidence-based practice for tonsillectomy in children for recurrent infection and an observed decrease in overall rate of tonsillectomy. This suggests the CPG may be an effective quality improvement tool for reducing variation and unnecessary patient morbidity or harm.
Implications For Practice:
These findings suggest that the updated AAO-HNSF CPG for Tonsillectomy in Children may have effectively impacted practice patterns, and further work should be done to expand their reach to other specialties and settings. Consideration should also be given to further understand any balancing factors associated with reduced tonsillectomies for recurrent infections including quality of life impact on children managed expectantly.
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