Characterizing a Department's Transition to Intracapsular Tonsillectomy: A Mixed Methods Analysis.

Area of Science:

• Otolaryngology
• Surgical Innovation
• Health Services Research

Background:

• Intracapsular tonsillectomy (IT) offers reduced complications and equivalent outcomes to total tonsillectomy (TT).
• Adoption of IT has been limited despite reported benefits.
• Changing surgical techniques for common procedures presents challenges.

Purpose of the Study:

• To examine barriers to adopting IT in a pediatric otolaryngology department.
• To describe the timeline, outcomes, and surgeon motivators during the transition from TT to IT.
• To identify factors influencing the adoption of newer surgical techniques.

Main Methods:

• Explanatory sequential mixed methods study.
• Analysis of 13,899 pediatric tonsillectomy cases (2017-2022).
• Review of 30-day postoperative return visits and semi-structured surgeon interviews.

Main Results:

• IT proportion increased from 2.3% to 80.8% over 6 years.
• IT patients had lower 30-day return rates (3.1%) compared to TT (10%).
• Key motivators included data transparency and surgeon experience; concerns involved patient families, training, and partner impact.

Conclusions:

• Departmental data transparency and a culture supporting best outcomes facilitate the adoption of safer surgical techniques like IT.
• Prominent agents of surgical change were identified, enabling scalable transitions.
• Successful implementation of IT requires addressing surgeon-specific motivators and transition concerns.