Center for Surgical Outcomes Research and Center for Innovation in Pediatric Practice, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH.
Department of Otolaryngology, Nationwide Children's Hospital, Columbus, OH; Department of Otolaryngology, The Ohio State University College of Medicine, Columbus, OH.
J Pediatr. 2020 May;220:116-124.e3. doi: 10.1016/j.jpeds.2020.01.061. Epub 2020 Mar 11.
To evaluate whether differences in pediatric tonsillectomy use by race/ethnicity and type of insurance were impacted by the American Academy of Otolaryngology-Head and Neck Surgery's 2011 tonsillectomy clinical practice guidelines.
We included children aged <15 years from Florida or South Carolina who underwent tonsillectomy in 2004-2017. Annual tonsillectomy rates within groups defined by race/ethnicity and type of health insurance were calculated using US Census data, and interrupted time series analyses were used to compare the guidelines' impact on utilization across groups.
The average annual tonsillectomy rate was greater among non-Hispanic white children (66 procedures per 10 000 children) than non-Hispanic black (38 procedures per 10 000 children) or Hispanic children (41 procedures per 10 000 children) (P < .001). From the year before to the year after the guidelines' release, tonsillectomy use decreased among non-Hispanic white children (-11.1 procedures per 10 000 children), but not among non-Hispanic black (-0.9 procedures per 10 000 children) or Hispanic children (+3.9 procedures per 10 000 children) (P < .05). Use was greater among publicly than privately insured children (75 vs 52 procedures per 10 000 children, P < .001). The guidelines were associated with a reversal of the upward trend in use seen in 2004-2010 among publicly insured children (-5.5 procedures per 10 000 children per year, P < .001).
Tonsillectomy use is greatest among white and publicly insured children. However, the American Academy of Otolaryngology-Head and Neck Surgery's 2011 clinical practice guideline statement was associated with an immediate decrease and change in use trends in these groups, narrowing differences in utilization by race/ethnicity and type of insurance.
评估种族/民族和保险类型差异对小儿扁桃体切除术的影响是否受美国耳鼻喉科学会-头颈外科学会 2011 年扁桃体切除术临床实践指南的影响。
我们纳入了 2004 年至 2017 年间在佛罗里达州或南卡罗来纳州接受扁桃体切除术的<15 岁儿童。使用美国人口普查数据计算按种族/民族和健康保险类型划分的组内每年扁桃体切除术的比率，并使用中断时间序列分析比较指南对各组利用的影响。
非西班牙裔白人儿童的平均每年扁桃体切除术率（每 10 000 名儿童 66 例手术）高于非西班牙裔黑人（每 10 000 名儿童 38 例手术）或西班牙裔儿童（每 10 000 名儿童 41 例手术）（P<0.001）。从指南发布前一年到发布后一年，非西班牙裔白人儿童的扁桃体切除术使用率下降（每 10 000 名儿童减少 11.1 例手术），而非西班牙裔黑人（每 10 000 名儿童减少 0.9 例手术）或西班牙裔儿童（每 10 000 名儿童增加 3.9 例手术）的使用率则无变化（P<0.05）。与私人保险相比，公共保险的儿童使用率更高（每 10 000 名儿童 75 例 vs 52 例手术，P<0.001）。指南与公共保险儿童 2004-2010 年使用率上升趋势的逆转有关（每年每 10 000 名儿童减少 5.5 例手术，P<0.001）。
白人儿童和公共保险的儿童扁桃体切除术使用率最高。然而，美国耳鼻喉科学会-头颈外科学会 2011 年临床实践指南声明与这些群体的使用率立即下降和利用趋势的变化有关，缩小了种族/民族和保险类型利用方面的差异。
