Enhancing adherence to tonsillectomy guidelines: a quality improvement audit in a resource-limited setting

Recurrent tonsillitis significantly impacts pediatric populations globally, with tonsillectomy serving as the standard intervention. The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) provides guidelines to optimize perioperative care, but adherence in resource-limited settings remains suboptimal.

This study assessed adherence to AAO-HNS tonsillectomy guidelines at a tertiary healthcare center in Pakistan and evaluated the impact of an educational intervention on improving compliance and patient outcomes.

A two-cycle clinical audit was conducted, including 120 patients (60 per cycle). Baseline adherence to Key Action Statements (KAS) was assessed before an educational intervention targeting surgeons and staff. A follow-up audit measured post-intervention changes. Data analysis focused on adherence rates and clinical outcomes.

Pre-intervention adherence to critical guidelines - such as perioperative counseling (KAS 9) and intraoperative dexamethasone use (KAS 11) - was low. Following the intervention, adherence to KAS 11 increased from 60% to 100% (P < 0.01), and perioperative counseling improved from 20% to 48.3%. Postoperative ibuprofen use also rose significantly (6.7% to 63.3%). However, persistent gaps remained, particularly in the use of polysomnography for diagnosing obstructive sleep apnea due to financial constraints and resistance to changing perioperative antibiotic practices.

This clinical audit suggests that targeted educational interventions can improve adherence to AAO guidelines for tonsillectomy in the short term. However, long-term monitoring and structured follow-up are needed to ensure sustained adherence. Future strategies should explore cost-effective diagnostic alternatives, such as the STBUR scale, and address entrenched clinical practices through ongoing education and policy reinforcement.