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Original Investigation |

Current Pediatric Tertiary Care Admission Practices Following Adenotonsillectomy

Heather C. Nardone, MD1; Katherine M. McKee-Cole, MD1; Norman R. Friedman, MD2
[+] Author Affiliations
1Division of Pediatric Otolaryngology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
2Division of Pediatric Otolaryngology, Colorado Children’s Hospital, Aurora
JAMA Otolaryngol Head Neck Surg. 2016;142(5):452-456. doi:10.1001/jamaoto.2016.0051.
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Published online

Importance  Pediatric adenotonsillectomy is a frequently performed procedure. Few studies have examined perioperative practice patterns for children undergoing adenotonsillectomy.

Objective  To assess current group practice patterns associated with the perioperative care of children undergoing adenotonsillectomy for sleep-disordered breathing at tertiary care children’s hospitals following the release of the 2011 American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) clinical practice guidelines.

Design, Setting, and Participants  A cross-sectional survey was distributed to the chiefs of 72 pediatric otolaryngology divisions at tertiary care children’s hospitals in the United States and Canada from March 25 to April 16, 2014.

Main Outcomes and Measures  Internet-based survey responses from the chiefs of pediatric otolaryngology at tertiary care children’s hospitals in the United States and Canada, who responded regarding group, rather than individual, practices.

Results  Of the 72 surveys sent, 48 responses (67%) were received. Twenty-one respondents (44%) reported that their group has no official admission policy for children with sleep-disordered breathing. Seventy-three percent (29 of 40) reported using some measure of obesity as a criterion for postoperative admission. The AAO-HNS polysomnography criteria for severe obstructive sleep apnea were used by 40% of respondents (16 of 40) as admission criteria, whereas 15% (6 of 40) used the American Academy of Pediatrics criteria for severe obstructive sleep apnea. Seventy-three percent (29 of 40) reported requiring a child to be asleep while breathing room air without oxygen desaturation before discharge to home. An established minimum time for observation was reported by 43 of the respondents (90%). Institution size or volume of adenotonsillectomies performed did not affect the results.

Conclusions and Relevance  Many tertiary care children’s hospitals in the United States do not have an official admission policy to guide adenotonsillectomy care. Even for institutions that do have an official admission policy, the policies are not universally aligned with the AAO-HNS clinical practice guidelines. These survey results demonstrate an opportunity to improve quality and safety regarding admission policy practice patterns after pediatric adenotonsillectomy.

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Figure 1.
Admission Criteria After Adenotonsillectomy

Percentage of respondents using the criteria shown as an indication for admission. AHI indicates apnea-hypopnea index; BMI, body mass index (calculated as weight in kilograms divided by height in meters squared); OSA, obstructive sleep apnea; PSG, polysomnography.

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Figure 2.
Observation Time After Outpatient Adenotonsillectomy

Minimum time reported by respondents that a patient is observed prior to discharge home.

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Figure 3.
Preoperative Polysomnography Criteria

Percentage of respondents using criteria shown as indication for polysomnography before adenotonsillectomy.

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