Division of Pediatric Medicine, Pediatric Outcomes Research Team (PORT), Department of Pediatrics, Institute of Health Policy, Evaluation and Management, University of Toronto, Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Canada;
Pediatrics. 2014 Feb;133(2):280-8. doi: 10.1542/peds.2013-1884. Epub 2014 Jan 20.
To describe the quality of care for routine tonsillectomy at US children's hospitals.
We conducted a retrospective cohort study of low-risk children undergoing same-day tonsillectomy between 2004 and 2010 at 36 US children's hospitals that submit data to the Pediatric Health Information System Database. We assessed quality of care by measuring evidence-based processes suggested by national guidelines, perioperative dexamethasone and no antibiotic use, and outcomes, 30-day tonsillectomy-related revisits to hospital.
Of 139,715 children who underwent same-day tonsillectomy, 10,868 (7.8%) had a 30-day revisit to hospital. There was significant variability in the administration of dexamethasone (median 76.2%, range 0.3%-98.8%) and antibiotics (median 16.3%, range 2.7%-92.6%) across hospitals. The most common reasons for revisits were bleeding (3.0%) and vomiting and dehydration (2.2%). Older age (10-18 vs 1-3 years) was associated with a greater standardized risk of revisits for bleeding and a lower standardized risk of revisits for vomiting and dehydration. After standardizing for differences in patients and year of surgery, there was significant variability (P < .001) across hospitals in total revisits (median 7.8%, range 3.0%-12.6%), revisits for bleeding (median 3.0%, range 1.0%-8.8%), and revisits for vomiting and dehydration (median 1.9%, range 0.3%-4.4%).
Substantial variation exists in the quality of care for routine tonsillectomy across US children's hospitals as measured by perioperative dexamethasone and antibiotic use and revisits to hospital. These data on evidence-based processes and relevant patient outcomes should be useful for hospitals' tonsillectomy quality improvement efforts.
描述美国儿童医院常规扁桃体切除术的护理质量。
我们对 2004 年至 2010 年间在向儿科健康信息系统数据库提交数据的 36 家美国儿童医院接受日间扁桃体切除术的低危儿童进行了回顾性队列研究。我们通过测量国家指南建议的基于证据的手术过程、围手术期地塞米松和不使用抗生素的使用情况以及 30 天扁桃体切除术后相关医院复诊的结果来评估护理质量。
在 139715 名接受日间扁桃体切除术的儿童中，有 10868 名（7.8%）在 30 天内因扁桃体切除术相关的原因到医院复诊。各医院地塞米松（中位数 76.2%，范围 0.3%-98.8%）和抗生素（中位数 16.3%，范围 2.7%-92.6%）的使用情况存在显著差异。复诊的最常见原因是出血（3.0%）和呕吐及脱水（2.2%）。年龄较大（10-18 岁比 1-3 岁）与出血的标准化复诊风险增加和呕吐及脱水的标准化复诊风险降低相关。在对患者和手术年份的差异进行标准化后，各医院之间的总复诊（中位数 7.8%，范围 3.0%-12.6%）、出血复诊（中位数 3.0%，范围 1.0%-8.8%）和呕吐及脱水复诊（中位数 1.9%，范围 0.3%-4.4%）存在显著差异（P<.001）。
在围手术期地塞米松和抗生素的使用以及医院复诊方面，美国儿童医院常规扁桃体切除术的护理质量存在显著差异。这些基于证据的手术过程和相关患者结局的数据应有助于医院开展扁桃体切除术质量改进工作。
