Background: Tonsillectomy is the second most common pediatric surgery in the US. In 2011, the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) published a clinical practice guideline recommending against perioperative antibiotics for pediatric tonsillectomy. The impact of this guideline across children's hospitals is unknown.
Methods: We examined perioperative antibiotic use in children undergoing routine tonsillectomy at 34 freestanding children's hospitals in the Pediatric Health Information System (PHIS). We included patients >1 and <19 years old with tonsillectomy between 2009 and 2013, excluding children with high-risk conditions, additional surgical procedures, or admitted from the emergency department. Perioperative antibiotic use was defined as a billing charge for antibiotics on the day of surgery. Using a longitudinal piecewise logistic model with a knot at Quarter 1, 2011 (guideline publication), we modeled prescribing trajectory before and after guideline publication. Analysis standardized for patient demographics, comorbid conditions, and surgery indication, and adjusted for clustering by hospital.
Results: Overall, 23,273 of 121,918 (19%) eligible children received antibiotics on the day of surgery; 26% in the 2 years before and 15% in the 3 years after guideline publication. Perioperative antibiotic use was declining prior to guideline publication, and continued to decline at a similar rate afterward (Figure 1). Immediately following guideline publication, there was a non-significant drop in antibiotic use (p=0.113). At 29 of 34 hospitals, use was lower in the study period after publication compared to before (average percentage point change -16%, range -1% to -87%). Three hospitals increased use (percentage point change 6%, 6% and 41%). Guideline-recommended dexamethasone use had a non-significant increase in slope following guideline publication (p=0.194).
Conclusion: The 2011 AAO-HNS guideline did not significantly reduce antibiotic prescribing for tonsillectomy across freestanding children's hospitals. Although most children do not receive perioperative antibiotics, the frequency of this procedure suggests that this remains an important target for antimicrobial stewardship.
J. S. Gerber, None