Antibiotics to reduce post-tonsillectomy morbidity

Dhiwakar, Muthuswamy; Clement, W A; Supriya, Mrinal; McKerrow, W. S.

doi:10.1002/14651858.cd005607.pub3

Cited by 43 publications

(54 citation statements)

References 38 publications

(2 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Dhiwakar et al [22] in their meta-analysis of ten studies in the Cochrane review found no significant reduction in post-tonsillectomy bleeding and the routine use of prophylactic antibiotic. We found no statistically significant evidence for the use of prophylactic antibiotics in reducing secondary haemorrhage.…”

Section: Discussionmentioning

confidence: 98%

High Incidence of Post-Tonsillectomy Secondary Haemorrhage Following Coblation Tonsillectomy

Praveen

Parthiban

Terry

2012

Indian J Otolaryngol Head Neck Surg

View full text Add to dashboard Cite

To examine the incidence of haemorrhage following tonsillectomy, to explore the usefulness of antibiotic in preventing postoperative haemorrhage and to examine if the haemorrhage depended on the level of expertise of the surgeon. A retrospective review analysing tonsillectomy method, the rate secondary haemorrhage, the grade of operating surgeon. A v 2 analysis was used to determine the statistical difference between the haemorrhage rates of different tonsillectomy methods. One thousand three hundred and thirty-six tonsillectomies were performed during this period by four different methods: 615 by cold steel dissection, 582 by Coblation, 32 by bipolar dissection and 107 by Helica thermal coagulation. 621 tonsillectomies were performed by Consultant grade and middle grades performed 693 operations. 124 patients (9.3 %) were readmitted with haemorrhage. The secondary haemorrhage requiring surgery for controlling bleeding for cold steel dissection method was 1.5 % compared to 6.7 % for coblation method (P \ 0.01 %), 6.3 % for bipolar dissection and 1.9 % for Helica thermal coagulation method. Overall consultants had a post tonsillectomy haemorrhage rate of 5.5 % and middle grades had a rate of 3.7 %. 86.5 % of the patients were already on routine prophylactic oral antibiotics at the time of presentation with haemorrhage needing surgical arrest and 13.5 % were not on antibiotics (P \ 0.05 %). There was statistically significant difference in secondary haemorrhage rate between coblation and cold steel dissection methods. Coblation tonsillectomies had an increased need for operative intervention to control secondary haemorrhage. Routine use of antibiotic and expertise of operating surgeon had no bearing on secondary haemorrhage rate.

show abstract

Section: Discussionmentioning

confidence: 98%

High Incidence of Post-Tonsillectomy Secondary Haemorrhage Following Coblation Tonsillectomy

Praveen

Parthiban

Terry

2012

Indian J Otolaryngol Head Neck Surg

View full text Add to dashboard Cite

show abstract

“…Outcomes, such as length of postoperative stay and unplanned overnight admission, may be more closely linked to a reduction in postoperative nausea and vomiting. As antibiotics have not been shown to reduce posttonsillectomy morbidity, 5 one would not expect to see a reduction in revisits, unless there were a significant number of antibiotic-associated adverse events that resulted in revisits.…”

Section: Figurementioning

confidence: 99%

“…These recommendations are based on evidence gathered from trials over the past 2 decades, 2,4,5 which showed that dexamethasone, administered on the day of surgery, reduces postoperative nausea, vomiting, and pain, 4 whereas perioperative antibiotics do not reduce postoperative bleeding, pain, or infections. 5 The guideline recommends monitoring bleeding rates, as bleeding is the most common and serious complication. 6,7 To understand potential opportunities for quality improvement around tonsillectomy care, information is needed on perioperative evidence-based processes suggested by guidelines, such as dexamethasone and antibiotic use.…”

mentioning

confidence: 99%

Variation in Quality of Tonsillectomy Perioperative Care and Revisit Rates in Children’s Hospitals

et al. 2014

View full text Add to dashboard Cite

WHAT'S KNOWN ON THIS SUBJECT: Tonsillectomy is one of the most commonly performed surgeries in children and is one of the most cumulatively expensive conditions in pediatric hospital care. Little is known about how the quality of tonsillectomy care varies across hospitals. WHAT THIS STUDY ADDS:In a large cohort of low-risk children undergoing same-day tonsillectomy, there was substantial variation in quality measures of process, dexamethasone and antibiotic use, and outcome, revisits to the hospital within the first 30 days after surgery. abstract OBJECTIVE: To describe the quality of care for routine tonsillectomy at US children' s hospitals. METHODS: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. RESULTS: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%).CONCLUSIONS: 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. Pediatrics 2014;133:280-288

show abstract

“…Both recommendations are based on evidence from randomized controlled trials. 8,9 In our previous study of children undergoing same-day tonsillectomy at children's hospitals before guideline publication, 69.6% received dexamethasone and 31.3% received antibiotics. 7 The guidelines also make recommendations for hospitals to implement effective pain management strategies, with discharge education to caregivers for pain assessment and management at home.…”

mentioning

confidence: 99%

Association of National Guidelines With Tonsillectomy Perioperative Care and Outcomes

et al. 2015

View full text Add to dashboard Cite

To investigate the association of the 2011 American Academy of Otolaryngology Head and Neck Surgery guidelines with perioperative care processes and outcomes in children undergoing tonsillectomy. METHODS:We conducted a retrospective cohort study of otherwise healthy children undergoing tonsillectomy between January 2009 and January 2013 at 29 US children's hospitals participating in the Pediatric Health Information System. We measured evidence-based processes suggested by the guidelines (perioperative dexamethasone and no antibiotic use) and outcomes (30-day tonsillectomy complication-related revisits). We analyzed rates aggregated over the preguideline and postguideline periods and then by month over time by using interrupted time series.RESULTS: Of 111 813 children who underwent tonsillectomy, 54 043 and 57 770 did so in the preguideline and postguideline periods, respectively. Dexamethasone use increased from 74.6% to 77.4% (P , .001) in the preguideline to postguideline period, as did its rate of change in use (percentage change per month, 20.02% to 0.29%; P , .001). Antibiotic use decreased from 34.7% to 21.8% (P , .001), as did its rate of change in use (percentage change per month, 20.17% to 20.56%; P , .001). Revisits for bleeding remained stable; however, total revisits to the hospital for tonsillectomy complications increased from 8.2% to 9.0% (P , .001) because of an increase in revisits for pain. Hospital-level results were similar. CONCLUSIONS:The guidelines were associated with some improvement in evidence-based perioperative care processes but no improvement in outcomes. Dexamethasone use increased slightly, and antibiotic use decreased substantially. Revisits for tonsillectomy-related complications increased modestly over time because of revisits for pain. WHAT'S KNOWN ON THIS SUBJECT:Tonsillectomy guidelines make evidence-based recommendations for the perioperative use of dexamethasone, no routine use of antibiotics, and discharge education of families and for surgeons to monitor bleeding complication rates. The impact of the guidelines on processes and outcomes is unknown. WHAT THIS STUDY ADDS:The guidelines were associated with improvement in perioperative care processes but no improvement in outcomes. Perioperative dexamethasone use increased slightly, and antibiotic use decreased substantially. Bleeding rates were stable, but revisit rates for complications increased because of revisits for pain.

show abstract

Antibiotics to reduce post-tonsillectomy morbidity

Cited by 43 publications

References 38 publications

High Incidence of Post-Tonsillectomy Secondary Haemorrhage Following Coblation Tonsillectomy

High Incidence of Post-Tonsillectomy Secondary Haemorrhage Following Coblation Tonsillectomy

Variation in Quality of Tonsillectomy Perioperative Care and Revisit Rates in Children’s Hospitals

Association of National Guidelines With Tonsillectomy Perioperative Care and Outcomes

Contact Info

Product

Resources

About