Researchers led by a team at UT Southwestern Medical Center have created a statistical model to discover standards for typical, high, or low rates of bleeding after pediatric tonsillectomies. The findings, published in JAMA Otolaryngology-Head & Neck Surgery, could help doctors and hospitals improve outcomes for the third-most common pediatric surgery within the U.S.

This model is a useful instrument to incorporate in quality and safety initiatives around tonsillectomies. Now, doctors have a validated model to evaluate their bleeding rates against.”

Romaine Johnson, M.D., First Writer, Professor of Otolaryngology-Head and Neck Surgery at UTSW and the Department’s Director of Quality and Safety

In 2019, the American Academy of Otolaryngology-Head and Neck Surgery Foundation issued updated guidelines for pediatric tonsillectomies, which really useful that surgeons self-monitor their patients’ bleeding rates after these procedures. Ron Mitchell, M.D., UTSW Professor of Otolaryngology-Head and Neck Surgery and Chief of Pediatric Otolaryngology, was lead creator on those guidelines and on the present study.

Although complications after tonsillectomies are rare, Dr. Johnson said, excessive bleeding is one of the crucial common and is usually considered a consider the only a few deaths related to this surgery. The change in guidelines was a big step toward helping improve tonsillectomy safety, he said, but physicians faced a big hurdle in using them effectively. No standards existed to tell doctors whether their personal or institutional bleeding rates were considered normal, high, or low.

To develop probability standards, Dr. Johnson and his colleagues collected data from the Kid’s Hospital Association’s Pediatric Health Information System database, which incorporates de-identified patient information covering inpatient stays, outpatient surgeries, emergency department visits, and remark unit patient data from greater than 49 not-for-profit kid’s hospitals within the U.S.

The researchers were primarily all for data involving patients who got here to the emergency department or were readmitted for bleeding after tonsillectomies – an indication that their bleeding after the procedure was considered excessive. Researchers collected demographic data on these patients in addition to medical histories.

After stratifying bleeding rates for these institutions into percentiles, the team found that the median probability rate for bleeding amongst all patients was 1.97%. The bottom rate hovered just over 1%, and the best rate, within the 99th percentile, was 6.4%. Variables related to increased rates of post-tonsillectomy bleeding included adolescent age (older than 12), Hispanic ethnicity, residence in a comparatively high-wealth ZIP code, and obesity.

Dr. Johnson emphasized that the study didn’t account for surgical technique or the various tools available to perform tonsillectomies. Different training of surgeons could also affect results, a variable that is difficult to capture, he said. But Dr. Johnson stressed that technique might not be in charge for higher bleeding rates since many aspects outside a surgeon’s control contribute to risk, including a patient’s age or other comorbidities.

“This model provides a useful place to begin to assist surgeons look critically at their very own bleeding rates and help them understand why this complication might occur,” Dr. Johnson said.

Other UTSW researchers who contributed to this study include Dylan R. Beams, Stephen R. Chorney, Yann-Fuu Kou, Felicity Lenes-Voit, Seckin Ulualp, and Christopher Liu.

Dr. Johnson holds the Beth and Marvin C. “Cub” Culbertson Professorship in Pediatric Otolaryngology. He also serves as Director of the Pediatric Voice/FEES Clinic at Kid’s Medical Center Dallas. Dr. Mitchell holds the William Beckner, M.D., Distinguished Chair in Otolaryngology.

This study was funded by the Beth and Marvin “Cub” Culbertson Endowment in UTSW’s Department of Otolaryngology-Head and Neck Surgery.

Source:

UT Southwestern Medical Center

Journal reference:

Johnson, R. F., et al. (2023). Estimated Probability Distribution of Bleeding After Pediatric Tonsillectomy: A Retrospective National Cohort Study of US Children. JAMA Otolaryngology–Head & Neck Surgery. doi.org/10.1001/jamaoto.2023.0268.