The tragic case of California teenager Jahi McMath, age 13, who was confirmed as brain dead after she had tonsillectomy surgery, has brought numerous shocking facts over the complications of this medical procedure into the limelight. Young McMath suffered extreme bleeding from the tonsillectomy she had to help relieve her sleep apnea. She was moved to a different facility after the hospital where she had the surgery refused to continue to give her any life support such as a ventilator. There are over 500,000 tonsillectomies performed every year on children in the United States. This procedure is the second most common pediatric surgery.
Even though they are considered common, are they routine? Not really says a new research study that has just been released in the scientific journal Pediatrics. Researchers have discovered that the quality of class of care that happens before, during and after a tonsillectomy fluctuates greatly from hospital to hospital.
The main author of the research study, Dr. Sanjay Mahant, stated that he and his team were extremely surprised at the varying degree between hospitals in the different usage of medication treatments, and also how they scheduled comebacks to the hospitals after the surgeries if there were any complications that arose.
The researcher group studied information from a pediatric health bank, and they looked at approximately 139,150 children who were considered to be at low-risk for complications who had tonsillectomies between the years 2004 to 2010 at nearly 40 children’s hospitals all over the United States.
Specific guidelines that are from the American Academy of Head and Neck Surgery state that physicians give the drug dexamethasone on the day of the tonsillectomy. That drug is for reduction of pain after the surgery is over and also to help lessen nausea. The recommendations do not endorse giving any type of antibiotics because prior studies have shown that antibiotics have not aided in stopping pain, bleeding or even halting infections after the tonsillectomy was performed.
The research group also investigated to see if various hospitals were following these recommended courses of action. Mahant and his group also took into account the number of patients who had to return to the hospital within the first 30 days after they had the surgery performed for problems such as dehydration, bleeding, vomiting, infection, pain, and/or respiratory complications. They also found that nearly 70 percent of all patients had received the dexamethansone drug on the day they had their surgeries and over one third got antibiotics.
Approximately 10,870 children, which came to almost 8 percent ended up coming back to the hospital after they had been released, the majority were for dehydration, vomiting and/or bleeding. The ones who had vomiting usually came back around one to three days after being discharged. The ones who returned and had bleeding complications were most likely to be seen about a week after they had been released. It was also discovered that older age children in the range of 10 to 18 years was associated with a larger risk for coming back to the hospital for bleeding complications while the younger kids in the age range of 1 to 3 years were the ones who were more likely to have nausea.
The examiners also researched antibiotic and dexamethasone usage over a period of time, as well as the return to rate during the research study time period. Dexamethasone use never changed at all between the years of 2004 to 2010, but the use of antibiotics went down considerably. The hospital return to rate continued to stay about the same despite the antibiotic drop.
Mahant and the research group have started having webinars with different hospitals in order to educate them over the study outcomes and what they found. However, Mahant stated that there is much more work to be done in order to figure out how to reduce the comebacks to hospital for all the complications that are occurring. One of the ways to stop this is to study and learn at hospitals which perform tonsillectomies in high numbers.
A tonsillectomy is certainly necessary for some children; however, there are numerous unanswered questions about the benefits of tonsillectomies in treating certain medical problems, such as sleep apnea. This is why parents have to educate themselves about what their child has and research all the different treatment options. They also need to be asking all kinds of questions to make sure they are comfortable about the decisions they make. Scientists state that the chance of a child dying during a tonsillectomy is approximately one in 30,000.
In looking at hospitals that have comeback rates of nearly 13 percent, it is safe to say that they need to be learning how to decrease their return to rates down to the 3 percent rate which was seen at some of their fellow institutions. That number was the lowest seen.
Tonsillectomy surgery has been brought into the limelight and numerous shocking facts over the complications of this medical procedure have been exposed.
By Kimberly Ruble