Hession-Laband Eileen, Melvin Patrice, Shermont Herminia, Murphy Jane M, Bukoye Bola, Amin Manali
J Healthc Qual. 2018 Jul/Aug;40(4):217-227. doi: 10.1097/JHQ.0000000000000143.
Dehydration is a potentially preventable complication post-tonsillectomy and can result in an Emergency Department visit and/or readmission. Our objectives were to identify risk factors for dehydration readmissions and develop interventions to prevent them.
We used retrospective chart reviews to determine if increased intravenous (IV) hydration post-tonsillectomy prevented hospital readmissions for dehydration. All children aged 1-18 years who underwent tonsillectomy between July 1, 2007 and September 30, 2015 were included in this quality improvement study. Using the Pediatric Health Information System database, patients who experienced a readmission for dehydration within 72 hours of surgery were identified and validated with internal data. We analyzed the pre-implementation and post-implementation readmission rates after standardization of increased IV fluids (1.5 times maintenance). An interrupted time series analysis was used to estimate the effects of our hydration initiative.
Of 11,157 patients who underwent tonsillectomy during the study period, 96 (0.9%) met the criteria for readmissions for dehydration. The pre-implementation readmission rate was 1% compared to 0.2% post-implementation, a reduction of 82%.
The hydration initiative was associated with a significant decrease in hospital readmissions. This safe, low-cost, easy-to-implement approach to preventing dehydration post-tonsillectomy could be explored at other institutions.
脱水是扁桃体切除术后一种潜在可预防的并发症，可能导致患者前往急诊科就诊和/或再次入院。我们的目标是确定脱水再入院的风险因素，并制定预防措施。
我们采用回顾性病历审查，以确定扁桃体切除术后增加静脉补液是否能预防因脱水导致的再次入院。2007年7月1日至2015年9月30日期间接受扁桃体切除术的所有1至18岁儿童均纳入本质量改进研究。利用儿科健康信息系统数据库，识别并通过内部数据验证术后72小时内因脱水再次入院的患者。我们分析了增加静脉补液标准化（维持量的1.5倍）前后的再入院率。采用间断时间序列分析来评估我们的补液措施的效果。
在研究期间接受扁桃体切除术的11157例患者中，96例（0.9%）符合脱水再入院标准。实施前的再入院率为1%，实施后的再入院率为0.2%，降低了82%。
补液措施与医院再入院率显著降低相关。这种安全、低成本且易于实施的预防扁桃体切除术后脱水的方法可在其他机构进行探索。
