Outpatient Tonsillectomy in Children: Demographic and Geographic Variation in the United States, 2006

Boss, Emily F.; Marsteller, Jill A.; Simon, Alan E.

doi:10.1016/j.jpeds.2011.11.041

Cited by 140 publications

(167 citation statements)

References 25 publications

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“…Adenotonsillectomy is the primary treatment for childhood OSAS (25); 26% of children in this study had either an elevated AHI or a prior history of adenotonsillectomy. Although the indications for adenotonsillectomy in these subjects were not available, in general, the commonest indication for adenotonsillectomy is obstructed breathing (31), with 59-69% of tonsillectomies in the United States being performed for obstruction (32). Thus, these data suggest that as many as one-quarter of very low birth weight infants may develop OSAS.…”

Section: Discussionmentioning

confidence: 96%

Long-Term Effects of Caffeine Therapy for Apnea of Prematurity on Sleep at School Age

Marcus

Meltzer

Roberts

et al. 2014

Am J Respir Crit Care Med

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Rationale: Apnea of prematurity is a common condition that is usually treated with caffeine, an adenosine receptor blocker that has powerful influences on the central nervous system. However, little is known about the long-term effects of caffeine on sleep in the developing brain.Objectives: We hypothesized that neonatal caffeine use resulted in long-term abnormalities in sleep architecture and breathing during sleep.Methods: A total of 201 ex-preterm children aged 5-12 years who participated as neonates in a double-blind, randomized, controlled clinical trial of caffeine versus placebo underwent actigraphy, polysomnography, and parental sleep questionnaires. Coprimary outcomes were total sleep time on actigraphy and apnea-hypopnea index on polysomnography.Measurements and Main Results: There were no significant differences in primary outcomes between the caffeine group and the placebo (adjusted mean difference of 26.7 [95% confidence interval (CI) = 215.3 to 2.0 min]; P = 0.13 for actigraphic total sleep time; and adjusted rate ratio [caffeine/placebo] for apnea-hypopnea index of 0.89 [95% CI = 0.55-1.43]; P = 0.63). Polysomnographic total recording time and total sleep time were longer in the caffeine group, but there was no difference in sleep efficiency between groups. The percentage of children with obstructive sleep apnea (8.2% of caffeine group versus 11.0% of placebo; P = 0.22) or elevated periodic limb movements of sleep (17.5% in caffeine group versus 11% in placebo group) was high, but did not differ significantly between groups.Conclusions: Therapeutic neonatal caffeine administration has no long-term effects on sleep duration or sleep apnea during childhood. Ex-preterm infants, regardless of caffeine status, are at risk for obstructive sleep apnea and periodic limb movements in later childhood.

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Section: Discussionmentioning

confidence: 96%

Long-Term Effects of Caffeine Therapy for Apnea of Prematurity on Sleep at School Age

Marcus

Meltzer

Roberts

et al. 2014

Am J Respir Crit Care Med

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“…We classified the indication for surgery into 2 categories: infection (children who had an infectionrelated code) or not infection related (children who had an airway obstruction or other diagnosis code), based on a previous ICD-9-CM classification. 1 …”

Section: Covariatesmentioning

confidence: 99%

“…1,2 It is the second most common and the ninth most cumulatively expensive reason for care in US children' s hospitals. 3 The 2011 American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) practice guidelines delineate high-quality tonsillectomy perioperative care.…”

mentioning

confidence: 99%

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

et al. 2014

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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

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“…1,2 Currently, the most common indication for tonsillectomy is obstructive sleep-disordered breathing (OSDB) (ie, breathing difficulties during sleep, including simple snoring, obstructive sleep apnea [OSA], and upper airway resistance syndrome). OSDB results from obstruction or dynamic collapse of upper airway soft tissue during sleep, which can manifest as snoring, hypopnea, apnea, and restless sleep.…”

mentioning

confidence: 99%

Tonsillectomy for Obstructive Sleep-Disordered Breathing: A Meta-analysis

Chinnadurai¹,

Jordan²,

Sathe

et al. 2017

Pediatrics

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CONTEXT: The effectiveness of tonsillectomy or adenotonsillectomy (hereafter, "tonsillectomy") for obstructive sleep-disordered breathing (OSDB) compared with watchful waiting with supportive care is poorly understood. OBJECTIVE:To compare sleep, cognitive or behavioral, and health outcomes of tonsillectomy versus watchful waiting with supportive care in children with OSDB.DATA SOURCES: Medline, Embase, and the Cochrane Library. STUDY SELECTION:Two investigators independently screened studies against predetermined criteria. DATA EXTRACTION:Two investigators independently extracted key data. Investigators independently assessed study risk of bias and the strength of the evidence of the body of literature. Investigators synthesized data qualitatively and meta-analyzed apnea-hypopnea index (AHI) scores. RESULTS:We included 11 studies. Relative to watchful waiting, most studies reported better sleep-related outcomes in children who had a tonsillectomy. In 5 studies including children with polysomnography-confirmed OSDB, AHI scores improved more in children receiving tonsillectomy versus surgery. A meta-analysis of 3 studies showed a 4.8-point improvement in the AHI in children who underwent tonsillectomy compared with no surgery. Sleeprelated quality of life and negative behaviors (eg, anxiety and emotional lability) also improved more among children who had a tonsillectomy. Changes in executive function were not significantly different. The length of follow-up in studies was generally <12 months. LIMITATIONS:Few studies fully categorized populations in terms of severity of OSDB; outcome measures were heterogeneous; and the durability of outcomes beyond 12 months is not known. CONCLUSIONS:Tonsillectomy can produce short-term improvement in sleep outcomes compared with no surgery in children with OSDB. Understanding of longer-term outcomes or effects in subpopulations is lacking.

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Outpatient Tonsillectomy in Children: Demographic and Geographic Variation in the United States, 2006

Cited by 140 publications

References 25 publications

Long-Term Effects of Caffeine Therapy for Apnea of Prematurity on Sleep at School Age

Long-Term Effects of Caffeine Therapy for Apnea of Prematurity on Sleep at School Age

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

Tonsillectomy for Obstructive Sleep-Disordered Breathing: A Meta-analysis

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