Hospital and Surgeon Adherence to Pediatric Tonsillectomy Guidelines Regarding Perioperative Dexamethasone and Antibiotic Administration

Abstract

Objectives: Evaluate change in true vocal fold length as function of age.Methods: Prospective study at tertiary aerodigestive center between 2011 and 2013. A total of 205 patients (ages 1 month to 20 years), of which 87 (42.4%) were female and 118 (57.6%) male, were included. Lengths of total vocal fold (TVFL), membranous vocal fold (MVFL), and cartilaginous vocal fold (CVFL) were measured during direct laryngoscopy. Membranousto-cartilaginous ratios (M/C) were calculated.Results: Mean MVFL under age 1 year for females was 4.4 ± 1.3 mm and for males 4.9 ± 1.8 mm. At age 17 years, mean MVFL was 12.3 ± 2.1 mm for females and 14.0 ± 1.4 mm for males. Mean TVFL, MVFL, and CVFL increased 0.7 mm, 0.5 mm, and 0.2 mm per year in linear fashion, respectively (linear regression, P < .0001). M/C ratio did not significantly change with age (P = .78). Mean TVFL, MVFL, and CVFL showed trend of being longer in males than females, but these did not reach statistical significance (P = .27; .11; .75, respectively).Conclusions: This is the largest longitudinal pediatric study specifically examining vocal fold length as function of age. Each length of true vocal fold appears to linearly increase for both females and males. M/C ratio remained relatively constant unlike previously reported data, possibly due to in vivo versus cadaveric measurements. These findings suggest critical periods of development in females and males are not explainable by changes in vocal fold length alone, and other factors such as vocal fold layers (linear density) need further exploration.

Antibiotic prescribing practices in otolaryngology head and neck surgery in Australia and New Zealand: a survey of 137 specialists

“…Our results indicate that while most surgeons did not prescribe any antibiotics for tonsillectomy ± adenoidectomy, a significant number prescribe post-operative antibiotics. Our findings were similar to previous studies in the USA where 30-40% of surgeons surveyed, prescribe antibiotics for these operations (10,12). Common reasons for prescribing antibiotics in this survey were prevention of infection, less post-operative pain and less post-operative bleeding.…”

“…Overall, this study highlights a gap between current guidelines and prescribing practices in some areas of Otolaryngology Head and Neck Surgery. Although evidence in Australia and New Zealand on adherence to guidelines is sparse, previous studies in the Netherlands and USA have emphasised a need for increased awareness and implementation of guidelines in the future (9,10). Furthermore, the Australian Commission on Safety and Quality in Health Care have highlighted the need for increased collaboration with the Royal Australasian College of Surgeons to improve this gap (3).…”

“…Previous studies in Netherlands suggest that while approximately 70% of Otolaryngologists, Head and Neck Surgeons were aware of national and international, guidelines, adherence rates were only 45% (9). Although studies in the USA demonstrated a higher adherence rate to guidelines in paediatric tonsillectomy patients, there was still a significant non-adherence rate emphasising the need for increased awareness and implementation in the future (10).…”

Clinical Practice Guideline: Tonsillectomy in Children (Update)

“…189 In addition, multiple studies have shown no significant change in pain, emergency room encounters, or hospitalization. 29,[190][191][192][193][194] Any real or theoretical benefit of antibiotics on recovery after tonsillectomy must be balanced against the known risks, harms, and adverse events of therapy. 195 Aside from the direct costs of acquiring the medications, adverse events include rash, allergy, and gastrointestinal upset or diarrhea.…”

Research Methods in Healthcare Epidemiology and Antimicrobial Stewardship: Use of Administrative and Surveillance Databases

“…Table 3 provides examples of research publications using different types of administrative data. -Centers for Medicare and Medicaid Services (CMS): MedPar, 69,70 state inpatient databases (SID), 35,52,[71][72][73] Medicaid Analytical eXtract (MAX), 74 Truven Health MarketScan® Multi-State Medicaid Database 75 -TRICARE 76 -University HealthSystem Consortium (UHC) 49 -Kids' Inpatient Database (KID) 77 -Pediatric Health Information System (PHIS) 47 -Premier Perspective 78,79 -Private insurers 11,12 85 -Individual health systems/ consortiums 9,12,23,27,28,37,[86][87][88][89] Surveillance, laboratory, or registry data -Defined as systematic collection of data for a clearly stated purpose -Can include both administrative and clinical data -Programs may allow multiple institutions to pool deidentified data for a common study.…”