Impact of Tonsillectomy Clinical Practice Guidelines

Abstract

Objective: To evaluate the effect of the recently published pediatric tonsillectomy and polysomnography clinical guidelines on current practice patterns. Method: An anonymous 15-question survey was sent to members of the American Academy of Otolaryngology–Head and Neck Surgery regarding their awareness of the Clinical Practice Guideline: Tonsillectomy in Children and Clinical Practice Guideline: Polysomnography for Sleep-Disordered Breathing Prior to Tonsillectomy in Children and whether or not they have changed their practice as a result. Results: A total of 93% of respondents read the guidelines. Most respondents had completed a pediatric otolaryngology fellowship (84%). A small majority of physicians (54%) continue to prescribe antibiotics within 24 hours after surgery. One-third of respondents stopped prescribing antibiotics because of the new guidelines. Discord between severity of symptoms and tonsil size was the most common reason cited for ordering a polysomnogram prior to tonsillectomy (76%) in concordance with the guideline’s recommendations. A total of 45% of physicians prescribe NSAIDs for pain control despite its safety profile, and 23% reported that the guidelines influenced their use of NSAIDs postoperatively. Most respondents use intraoperative steroids (90%). Conclusion: The guidelines are intended to provide evidence- based direction in tonsillectomy practices and improve referral patterns for polysomnography prior to tonsillectomy. A majority of the surveyed otolaryngologists reviewed these guidelines. There is some evidence practice has changed secondary to the guidelines.