Abstract
Objectives:
American Academy of Otolaryngology—Head and Neck Surgery 2011 guidelines for pediatric tonsillectomies recommend routine administration of perioperative dexamethasone and against routine antibiotic administration. The purpose of this study is to review adherence to these 2 guidelines.
Methods:
An observational cohort was reviewed of all children ages 1 to 18 years undergoing same-day-surgery adenotonsillectomy (T&A) at a multi-hospital network from 2007 to 2012. A standardized electronic data system was used to determine whether dexamethasone and/or antibiotics were given in the hospital. The rate of dexamethasone and antibiotic administration was compared in the years 2007 to 2011 (preguidelines) with the year 2012 (postguidelines).
Results:
The study cohort included 16,310 children undergoing T&A at 19 hospitals by 61 surgeons. A total of 91.3% of the patients from 2007 to 2011 (N = 13,557) received dexamethasone compared with 93.2% of the children in 2012 (N = 2,753). A total of 18.2% of the children from 2007 to 2011 received antibiotics compared with 14.7% in 2012 (P < .05). Dexame-thasone was given in the majority of cases before and after the guidelines were published. Seventeen of the 61 surgeons administered antibiotics in more than 50% of the cases in 2007 to 2011. Postguidelines in 2012, only 2 of these 17 surgeons adhered to the guidelines by not giving antibiotics in the majority of cases.
Conclusions:
The majority of hospitals and surgeons administered perioperative dexamethasone before and after the guidelines were published. While the rate of antibiotic administration statistically decreased in 2012 compared to 2007-2011, only 2 surgeons appeared to have changed their practice. With the purpose of the guideline to limit the risks and side effects of perioperative antibiotics, interventions are needed to improve guideline adherence.