Dang Quynh-Chi L, Román Emily, Donner Kimberly, Carsey Emily, Mitchell Ron F, Chorney Stephen R, Johnson Romaine F
Department of Otolaryngology, Head and Neck Surgery University of Texas, Southwestern Medical Center at Dallas Dallas Texas USA.
Laryngoscope Investig Otolaryngol. 2024 Sep 14;9(5):e1315. doi: 10.1002/lio2.1315. eCollection 2024 Oct.
In pediatric tonsillectomy management, the consistent tracking of surgical outcomes and adherence to guidelines are vital. This study explores how a surgical dashboard can serve as a tool in research analysis, translating AAO-HNSF guidelines into measurable performance improvements.
Using a prospective registry from three pediatric hospitals, a Tableau dashboard was constructed to graphically visualize key demographic and postoperative outcomes (including intensive care unit [ICU] utilization, 30-day emergency department (ED) visits, and postoperative bleed rates) in children undergoing tonsillectomy from 2020 to 2024. From the dashboard data, a retrospective cohort study analyzing 6767 tonsillectomies was conducted from January 2, 2020, to June 20, 2023. Patients were categorized into low-risk, OSA-only (by ICD-10 codes), and high-risk groups based on comorbidities. Logistic regression identified factors influencing ED revisits and unplanned nursing calls. Three quality initiatives were assessed: preoperative school absence notes, perioperative dexamethasone recording, and post-tonsillectomy parental education.
A total of 2122 (31%) were low-risk, 2648 (39%) were OSA-only, and 1997 (30%) high risk. Risk factors that increased the likelihood of ED visits were high-risk comorbidities (OR = 1.46; 95% CI = 1.24-1.74; < 0.001) and older age (OR = 1.05; 95% CI = 1.03-1.08; < 0.001). Risk factors that increased the likelihood of an unplanned nursing communication were high-risk comorbidities (OR = 1.53; 95% CI = 1.34-1.75; < 0.001), older age (OR = 1.03, 95% CI = 1.01-1.04; = 0.001), and Medicaid insurance (OR = 1.25; 95% CI = 1.09-1.43; = 0.002). Postoperative bleed control was generally comparable between the groups, at 2.8% (low risk), 2.7% (OSA), 3.2 (high risk) ( = 0.651).
The dashboard aided in data collection, data visualization, and data analysis of quality improvement initiatives, effectively translating guidelines into tangible measures to enhance care.
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在小儿扁桃体切除术管理中，持续跟踪手术结果并遵循指南至关重要。本研究探讨了手术仪表盘如何作为研究分析工具，将美国耳鼻咽喉头颈外科学会基金会（AAO-HNSF）指南转化为可衡量的性能改进。
利用来自三家儿科医院的前瞻性登记数据，构建了一个Tableau仪表盘，以图形方式直观呈现2020年至2024年接受扁桃体切除术儿童的关键人口统计学和术后结果（包括重症监护病房[ICU]使用率、30天内急诊就诊次数和术后出血率）。根据仪表盘数据，对2020年1月2日至2023年6月20日期间的6767例扁桃体切除术进行了回顾性队列研究。根据合并症将患者分为低风险、仅阻塞性睡眠呼吸暂停（按ICD-10编码）和高风险组。逻辑回归确定了影响急诊复诊和非计划护理呼叫的因素。评估了三项质量改进措施：术前缺课记录、围手术期地塞米松记录以及扁桃体切除术后家长教育。
共有2122例（31%）为低风险，2648例（39%）为仅阻塞性睡眠呼吸暂停，1997例（30%）为高风险。增加急诊就诊可能性的风险因素为高风险合并症（OR = 1.46；95% CI = 1.24 - 1.74；P < 0.001）和年龄较大（OR = 1.05；95% CI = 1.03 - 1.08；P < 0.001）。增加非计划护理沟通可能性的风险因素为高风险合并症（OR = 1.53；95% CI = 1.34 - 1.75；P < 0.001）、年龄较大（OR = 1.03，95% CI = 1.01 - 1.04；P = 0.001）和医疗补助保险（OR = 1.25；95% CI = 1.09 - 1.43；P = 0.002）。术后出血控制在各组之间总体相当，低风险组为2.8%，阻塞性睡眠呼吸暂停组为2.7%，高风险组为3.2%（P = 0.651）。
仪表盘有助于质量改进措施的数据收集、数据可视化和数据分析，有效地将指南转化为切实措施以改善护理。
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