(0225) Impact of Clinical Practice Guidelines on Tonsillectomy in Children with Tonsillitis

Introduction: On February 5, 2019, the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) published updated Clinical Practice Guidelines (CPG) for tonsillectomy in children (age 1-18) based on review of evidence. We hypothesized that the release of the updated CPG would lead to an increase in adherence to evidence-based practice in children undergoing tonsillectomy and a resulting decrease in rate of tonsillectomy due to more stringent criteria for the recommendation of tonsillectomy.

Methods: Encounters for throat infection (tonsillitis, pharyngitis, or both) in patients aged 1 to 18 between February 5, 2015 and February 4, 2023 (4 years pre and post-CPG) at a single tertiary care institution were pulled from the EMR by ICD-9 and ICD-10 codes. The subset who had tonsillectomy were identified, excluding those with sleep-disordered breathing. Demographics, adherence to evidence-based guidelines recommended in the CPG, and postoperative course were recorded for this subset through retrospective chart review. Chi square analysis evaluated adherence to evidence-based criteria for tonsillectomy and postoperative outcomes pre and post-CPG.

Results: There were 85,534 encounters for throat infection and 156 tonsillectomies (73.1% adherent to CPG) in the 4 years pre-CPG, and 101,413 encounters for throat infection and 144 tonsillectomies (85.4% adherent to CPG) in the 4 years post-CPG. This represented a 22.1% decrease in rate of tonsillectomy per encounter for throat infection. There was a significant difference in adherence to CPG (p = 0.00875). No significant differences were noted in rates of post-operative hemorrhage, unplanned readmission, or unplanned ED visits pre and post-CPG (p > 0.05).

Conclusions: The publication of updated AAO-HNSF CPG for tonsillectomy in children corresponded with reduced rate of pediatric tonsillectomy for throat infection and increased adherence to evidence-based criteria for tonsillectomy at a single institution.