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We aimed to evaluate factors associated with time to return to OR in children presenting with post-tonsillectomy hemorrhage to a tertiary children's hospital.Retrospective study of pediatric patients presenting to a single institution from January 2012 to January 2020, with post-tonsillectomy hemorrhage (PTH) requiring surgical intervention for control of bleeding. Correlation, univariate, and multivariate analysis were conducted.Of 15,984 tonsillectomies performed at our institution during the study period, 144 required return to the OR for bleeding control, in addition to 15 other children whose tonsillectomy had been performed at an outside institution. Mean time to the OR was 119.7 min (SD 101.5) in the morning, 77.4 min (SD 60.6) in the afternoon, 55.6 min (SD 34.8) in the evening, and 49.4 min (SD 26.4) overnight (ANOVA p 0.0001). The mean hemoglobin decline from pre-to post-tonsillectomy was 1.3 g/dl (SD 1.7). Primary hemorrhages had a mean time to OR of 62.39 min (SD 63.42) while secondary hemorrhages mean time to OR was 85.54 min (SD 76.21) (p = 0.0064). There was no significant difference in time to OR among race/ethnicity (p = 0.928), insurance status (p = 0.359), weekday (p = 0.557), surgeon seniority (p = 0.8104) or by hemoglobin drop (p = 0.2773). When controlling for each of these variables, multiple linear regression showed that only time of day had significant correlation with time to OR (p = 0.0003).At a tertiary children's hospital, patients presenting with PTH requiring revision surgery waited the longest to get to the OR in the morning versus all other times of day. These results can aid in individualization of anticipatory guidance in order to reduce morbidity and mortality from complications requiring revision in the operating room.

We aim to analyze factors associated with readmission after tonsillectomy to understand socioeconomic factors associated with readmission.Single institution retrospective study of pediatric patients undergoing tonsillectomy over an 8 year study period, comparing patients who required readmission for bleeding concerns or pain/dehydration to those who did not require readmission.Of the 14,152 tonsillectomy patients, 508 (3.6%) were readmitted with 423 (83.3%) for bleeding concerns and 85 (16.7%) for pain or dehydration. Overall readmission was more likely in age6 years (OR: 1.61, 95% CI: 1.34-1.92, P 0.001), while poverty level below 10% (OR: 0.79, 95% CI: 0.66-0.94, P = 0.008) and parental college education above 25% (OR: 0.79, 95% CI: 0.65-0.96, P = 0.016) were associated with lower incidence of overall readmission. For patients readmitted for bleeding concerns, age6 years (OR 1.66, 95% CI: 1.37-2.02, P 0.001) was associated with readmission on multivariate analysis. Within the pain/dehydration group, African American race was associated with increased readmission rates, while poverty level below 10% and parental college education above 25% were associated with decreased readmission rates.Socioeconomic factors and age play a role in readmission rates following pediatric tonsillectomy.

Objective To report the results of a preliminary analysis of a quality improvement initiative aimed to identify potential latent systems defects. Methods A pilot study of an anonymous, voluntary, event reporting system made available to all members of the American Academy of Otolaryngology-Head and Neck Surgery was performed. The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) index was used to classify error types. Descriptive statistics were used to summarize submissions to the database. Results In the 53 cases reported to the database over 22 months, the majority involved errors that had resulted in harm (n = 34, 64%), followed by errors that occurred and did not result in harm (n = 7, 13%). Errors occurred predominantly in the hospital (n = 23, 44%) and operating room (n = 19, 35%). Most entries were classified as either technical (n = 21, 39%) or related to postoperative care (n = 15, 30%). Discussion This preliminary descriptive analysis of a novel otolaryngology patient safety event reporting tool shows that this platform brings unique value to the identification of errors and adverse events in our specialty. Most reported events were classified as errors resulting in harm. The most common type of reported event was a technical error, most often resulting in a nerve injury. Implications for Practice This reporting tool will likely allow for identification and prioritization of improvement opportunities. This example may serve as a guide for other societies to create similar platforms as we strive for a standardized process for event reporting.

This article highlights the important relationship between the otolaryngologist and anesthesiologist, focusing on intraoperative patient safety for otolaryngologic surgery. In addition, consideration of preoperative history, physical examination, and potential postoperative complications helps guide the otolaryngologist and anesthesiologist in formulating an appropriate and collaborative management strategy.

Vascular anomalies are divided into tumors and malformations based on their clinical and cytologic attributes. Vascular malformations are further subcategorized as low-flow lymphatic, venous, capillary, or mixed lesions and as high-flow arteriovenous malformations. Treatment is reserved for vascular anomalies that are symptomatic or cosmetically disfiguring, and surgical and nonsurgical treatment options are widely varied with variable outcomes.

This study seeks to synthesize evidence-based findings related to patient satisfaction as a process measure in pediatric surgical care.PubMed, CINAHL, Scopus, and the Cochrane Central Register of Controlled Trials.We queried 4 standard search engines (1992-2013) for studies specific to pediatric surgical fields in which patient or parent satisfaction or experience of care was a primary outcome measure. Data were systematically analyzed to determine study characteristics, setting, parent or patient focus, measure of experience, and bias. Two independent investigators independently reviewed all articles.The initial search yielded 4748 publications (1503 duplicates), of which 170 underwent full-text review. Thirty-five were included for analysis; the majority (24/35,77%) were published in the last 5 years. Studies examined experience of the child (3/35), parent (23/35), or both (9/35). Experience and satisfaction were evaluated either by validated self-assessment instruments (8), by satisfaction tools (8), or by nonstandard institutional or author-developed tools (19). Experience was measured in the outpatient (7), preoperative (11), operative (14), and postoperative (3) care settings. Specific findings were unique to setting; however, in many studies higher satisfaction correlated with education/information giving, health care provider interpersonal behaviors, and facile/efficient care processes.The patient experience of care is a valuable quality measure that is being more frequently evaluated as a mechanism to improve pediatric surgical care processes. Findings related to patient satisfaction and experience of care may be limited due to lack of measurement using validated tools. Findings from this review may bear significance as patient experience measures become routinely integrated with quality and reimbursement.

Objectives:Synthesize evidence-based findings related to patient satisfaction as a quality indicator in pediatric surgical care.Methods:We conducted a qualitative systematic review, querying 4 standard search engines (1992-2013) for studies specific to pediatric surgical fields in which patient/parent satisfaction or experience-of-care was a primary outcome measure. Data were systematically analyzed to determine study characteristics, setting, parent/patient focus, measure of experience, and bias. Two independent investigators independently reviewed all articles.Results:The initial search yielded 4678 publications (1433 duplicates) of which 170 underwent full text review. Thirty-five were included for analysis; the majority (24/35,77%) were published in the last 5 years. Studies examined experience of the child (4/35), parent (19/35), or both (12/35). Experience and satisfaction were evaluated either by validated self-assessment instruments (9) or satisfaction tools (13), or by non-standard institutional ...

Objective: 1) To identify and define the cervical esophageal branches (CEB) of the recurrent laryngeal nerve (RLN), in vivo. 2) To study the feasibility of positively identifying the nonlaryngeal, ...

Importance Reviews of patient and caregiver experience with health practitioners are increasingly important to consumers. Understanding physician qualities valued by patients and their families may facilitate more effective care and communication. Objective To identify physician qualities and care dimensions valued by parents during their child’s outpatient surgical care encounter. Design Mixed-methods analysis of comments from patient-satisfaction surveys. Setting Outpatient pediatric otolaryngology and surgical specialty clinics in an urban tertiary care center. Participants Parents of children seen in pediatric otolaryngology and surgical specialty clinics who completed the physician section of the patient satisfaction survey. Main Outcomes and Measures Free-text comments written in the physician section of the survey. Results A total of 195 survey comments from visits to 18 surgical specialty clinics were analyzed; 64 comments (33%) were global in nature, of which 58 (90%) were positive; 25 of 195 comments (13%) discussed recommendation of care. Of the 131 comments (67%) with specific content, 79 (60%) were positive. Major themes were physician interpersonal style (n = 78, 45%), physician technical skills/knowledge/preparation (n = 82, 47%), and systems issues (n = 14, 8%). The most commonly noted interpersonal subthemes were inclusion/interaction with the child (20%) and empathy/concern for the patient’s needs (29%). The most common skills themes related to whether the physician answered questions (16%) or explained treatment (23%). The most common negative subgroup was inadequate explanation of treatment (18%). The majority of comments related to systems were negative (13 of 14, 93%). Conclusions and Relevance Parents highly value physician interpersonal style and visit-specific skills (involving the child in discussion; showing empathy/concern for the patient/family; answering questions; explaining treatment). While most comments about surgeons were affirmative, clinical systems were more often negatively perceived. Attention to parent-reported experiences may help physicians improve communication and overall effectiveness of care provided.