MONDAY, Jan. 20, 2014 (HealthDay News) -- A tonsillectomy is one
of the most routine surgeries for children, but what medication
kids get during and after the procedure varies widely among U.S.
hospitals, a new study finds.
In a review of tonsillectomies at 36 children's hospitals,
researchers found that the medical centers differed broadly when it
came to using antibiotics and the steroid dexamethasone.
Years of research have shown that a single dose of dexamethasone
during a tonsillectomy can control nausea and pain afterward, and
guidelines issued in 2011 recommend that most kids receive the
Antibiotics, on the other hand, have shown no benefit in
previous tonsillectomy studies, and the guidelines advise against
routinely giving them to patients.
But much depends on where your child has the surgery, said study
author Dr. Sanjay Mahant.
To be fair, Mahant said, this study does not mean hospitals are
ignoring guidelines. His team looked at hospitals' records from
2004 to 2010, before the 2011 guidelines were laid out by the
American Academy of Otolaryngology -- Head and Neck Surgery.
Still, the evidence behind those guidelines has been coming in
for years, said Mahant, a pediatrician at the Hospital for Sick
Children in Toronto.
"It's not surprising that we found variation among hospitals," he said. "But the degree of the variation was [surprising]."
Across the 36 U.S. hospitals, doctors gave kids dexamethasone an
average of three-quarters of the time, Mahant said. But there was a
big range, with some hospitals almost never giving the drug and
others almost always doing so.
When it came to antibiotics, the hospitals were a little closer
to the 2011 guidelines: About 16 percent of kids, on average, were
given antibiotics. But again there was a wide discrepancy, with a
couple of hospitals giving the drugs to almost every child.
There are some cases in which antibiotics are a good choice,
said Dr. Richard Rosenfeld, director of the Institute for Advanced
Otolaryngology at New York Methodist Hospital, in New York
"We're not expecting a zero rate of antibiotic use," said Rosenfeld, who helped craft the 2011 guidelines.
Similarly, some kids should not receive dexamethasone --
including those with diabetes or bleeding disorders. But for most
kids, Rosenfeld said, "dexamethasone should be routine."
"What you get from a single IV dose is pretty impressive," Rosenfeld said. "Over the first 24 hours, it cuts the risk of vomiting by 50 percent and reduces pain by about 25 percent."
He said it would be "perfectly appropriate" for parents to ask
whether their child will receive dexamethasone during a
tonsillectomy. "The answer should usually be yes," Rosenfeld said.
"If it's not, [the doctor] should explain why."
Mahant's team also found that hospitals varied widely in the
number of children who ended up back in the hospital within 30 days
-- usually for bleeding or vomiting and dehydration.
Of nearly 140,000 children in the study who had a tonsillectomy,
8 percent had to return to the hospital. But that varied from 3
percent to almost 13 percent, depending on the hospital.
Mahant said the reasons for the variation aren't clear, but it
was not due to hospitals' use or nonuse of dexamethasone.
Both Mahant and Rosenfeld said the findings point to
opportunities for improvement in hospitals' tonsillectomy
practices. Mahant noted that the Children's Hospital Association
funded the study. "They're interested in using the data to
improve," he said.
As for what parents can do, Mahant recommended asking doctors
what to expect after a tonsillectomy. Make sure you know what
number to call -- day and night -- if you're concerned about any
problems, he said.
In the United States, about half a million children have a
tonsillectomy each year. That's down from decades past, Rosenfeld
said, when tonsillectomies were commonly done to treat repeat
tonsil infections. These days, the procedure is most often done
when enlarged tonsils are causing obstructive sleep apnea, which
causes a child's breathing to repeatedly stop and restart during
"In general, it's a very safe surgery, and very effective," Rosenfeld said. But, he added, the fact that 8 percent of kids in this study had to return to the hospital shows that problems do arise.
Occasionally, those problems can be severe. Rosenfeld pointed to
the high-profile case of Jahi McMath, a 13-year-old who, in
December, suffered cardiac arrest after a tonsillectomy at
Children's Hospital Oakland, in California. She was later declared
The odds of a child dying after a tonsillectomy are about one in
30,000, Rosenfeld said. "I'm not trying to scare anyone away from
them," he said, but serious complications are possible with any
The new study findings were published online Jan. 20 in the
The National Institutes of Health has more on
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