Tonsillectomy procedures vary depending on hospital: Study

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Getting a tonsillectomy can vary depending on where you get the procedure done, a new study in Pediatrics reveals.

The research, which was published on Jan. 20, looked at 36 children’s hospitals that performed the procedure on almost 140,000 kids. They found that the facilities provided different levels of antibiotics and the steroid dexamethasone.

The researchers noted that doctors gave children dexamethasone 76 percent of the time. Previous research showed that children who were given the steroid during a tonsillectomy were less likely to throw up during the first 24 hours after the procedure and were more likely to start eating soft or solid foods the day after surgery.

The American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNS) recommended in 2011 that children receive one dose of dexamethasone after a tonsillectomy.

About 16 percent of kids received antibiotics after having their tonsils removed. Other studies have shown that antibiotic use after the procedure is not beneficial.

"Some care providers used to believe antibiotics reduced bleeding, but that has not been shown to be the case," Dr. Sanjay Mahant, a pediatrician at the Hospital for Sick Children in Toronto, said to USA Today.

The frequency of both prescriptions being doled out varied, with some hospitals giving them almost all the time and others prescribing rarely.

Eight percent of the children studied went back to the hospital within 30 days after the procedure, mostly due to bleeding, excessive vomiting or dehydration.  Children who were older -- between the ages of 10 and 18 -- were more likely to go back to the hospital because of bleeding than younger kids. Individual hospital return rates ranged from 3 percent to 13 percent.

The chance of complications was not linked to the use or nonuse of dexamethasone.

The AAO-HNS reports that about 530,000 tonsillectomies are done annually in children younger than 15 years old. Currently about 20 percent of those surgeries are done in response to recurrent infections, while 80 percent of cases are due to obstructive sleep problems. 

"In general, it's a very safe surgery, and very effective," Dr. Richard Rosenfeld, director of the Institute for Advanced Otolaryngology at New York Methodist Hospital in New York, said to HealthDay.

Rosenfeld, who was not involved in the study, said that he did not expect that all doctors would avoid antibiotics. The medication can be helpful in some cases. In addition, dexamethasone isn’t good for all kids, especially those with bleeding disorders and diabetes. But for the majority of children, it can cut the risk of vomiting in half and pain by a quarter. 

The recent case of Jahi McMath, a 13-year-old girl Calif. girl who was declared brain dead after she suffered extreme bleeding from a tonsillectomy procedure for sleep apnea, brought attention to rare but devastating complications that can occur.

The hospital refused to continue to provide support, including a ventilator, after she was declared brain dead, but her parents insisted that she was still alive. After a lengthy legal battle, the family was allowed to take Jahi to an undisclosed facility for long-term care.

Rosenfeld said the chance of a child dying during a tonsillectomy was about one in 30,000.  

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