‘Routine’ tonsillectomies not so routine

File photo - Surgery operating room (ThinkStock)

When Jahi McMath suffered severe complications following a tonsillectomy, and doctors declared her brain dead, many parents were shocked.

More than 500,000 tonsillectomies are performed each year on children in the United States; it’s the second most common pediatric surgery. But how routine are these procedures really?

Not so much, a new study published Monday in the scientific journal Pediatrics suggests. Researchers found the quality of care before, during and after a tonsillectomy varies greatly depending on the hospital.

When routine surgeries go wrong

“We were surprised at the degree of variation between hospitals in the use of medications … and revisits to hospitals after the surgery for complications,” said lead study author Dr. Sanjay Mahant.

The study

Researchers analyzed data from the Pediatric Health Information System, looking specifically at 139,155 low-risk children who underwent tonsillectomies between 2004 and 2010 at 36 children’s hospitals across the United States.

Guidelines from the American Academy of Otolaryngology-Head and Neck Surgery recommend doctors administer dexamethasone on the day of a tonsillectomy.  Dexamethasone is used to reduce nausea and pain after surgery. The guidelines do not recommend administering antibiotics because previous studies have shown that antibiotics do not help in preventing bleeding, pain or infection after a tonsillectomy.

In addition to looking at whether hospital staff followed these guidelines, Mahant and his team also calculated the number of patients who returned to the hospital in the 30 days after surgery for bleeding, vomiting/dehydration, pain, infection and/or respiratory problems.

The results

Close to 70% of patients received dexamethansone on the day of their surgery. Nearly a third received antibiotics.

A total of 10,868 children – about 7.8% – returned to the hospital after being discharged, most for bleeding and vomiting/dehydration. Those who came in with vomiting tended to return one to two days after being discharged. Those who returned with bleeding were most likely to come in six to seven days after.

Older children were more likely to suffer from bleeding problems while younger kids were more likely to experience nausea.

Trends

The researchers also looked at dexamethasone and antibiotic use over time, as well as the revisit rate during the study period. Dexamethasone use did not change between 2004 and 2010, but the use of antibiotics dropped significantly. The hospital revisit rate remained fairly stagnant.

Mahant and his team have held webinars with hospital administrators to educate them about the study results.

“There is definitely more work that needs to be done to understand how to reduce revisits to hospital for complications,” Mahant told CNN. “One way to investigate this is by studying and learning from high-performing hospitals.”

Keeping your kid safe

Parents and doctors should discuss the risks and benefits of any surgery, Mahant said.

For some children, a tonsillectomy is the necessary, or sensible option. However, he said, there are many unanswered questions regarding the the benefits of tonsillectomies for treating certain issues, such as sleep apnea.

“Parents should educate themselves about their child’s condition and treatment options, and ask questions so they feel comfortable about their decisions,” he said.

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