Variables associated with pediatric emergency department visits for uncontrolled pain in postoperative adenotonsillectomy patients

Jennifer M Lavin, David Lehmann, Astrid Leon Silva, Guangyu Bai, Ferdynand Hebal, Renee CB Manworren, Christine Elizabeth Stake, Karen Rychlik, Kathleen R Billings*

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Objective: Returns to the emergency department (ED) for pain or dehydration after adenotonsillectomy (T&A) are frequent. Attempts to associate the specific pain regimens with these visits have been unrevealing, suggesting a need to assess for other potential factors associated with readmission. Methods: A review of a 2:1 cohort matched by age, gender and payer status compared post-T&A patients who did not return ED for pain or dehydration within 21 days to those who returned. Factors investigated included patient demographics, comorbidities, medication regimen and the presence of postoperative telephone encounters. Patients returning to the ED were further assessed for rates of medication adherence. Results: 7493 patients underwent T&A during the period. Of these, 144 (1.9%) returned for pain/dehydration. Comparison to 285 matched patients revealed an association between ED returns and Hispanic ethnicity (p < 0.001), Spanish language (p = 0.0002), and comorbid Down syndrome and ADHD (p = 0.011 in both). The incidence of parent telephone calls to the office was associated with ED returns (58.7 in the ED cohort, 28.4% in non-ED cohort, p < 0.0001). On multivariable analysis, Hispanic ethnicity and phone calls were associated with ED returns (p < 0.0001 and p < 0.0001, respectively). Only 64.0% of patients returning to the ED were adherent with postoperative pain regimens. Conclusions: While demographic factors may be associated with rate of ED returns for pain and dehydration, post-operative phone calls were most highly associated with returns. The majority of patients returning to the ED were non-adherent with recommended pain regimens, suggesting an opportunity to investigate medication adherence in all post-tonsillectomy patients.

Original languageEnglish (US)
Pages (from-to)10-14
Number of pages5
JournalInternational journal of pediatric otorhinolaryngology
Volume123
DOIs
StatePublished - Aug 2019

Fingerprint

Postoperative Pain
Hospital Emergency Service
Pediatrics
Dehydration
Pain
Medication Adherence
Hispanic Americans
Telephone
Demography
Tonsillectomy
Down Syndrome
Comorbidity
Language
Incidence

Keywords

  • Adenotonsillectomy complications
  • Adenotonsillectomy pain
  • Pediatric adenotonsillectomy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Otorhinolaryngology

Cite this

@article{eb1a49a9402345d3a3406ae64d10e65e,
title = "Variables associated with pediatric emergency department visits for uncontrolled pain in postoperative adenotonsillectomy patients",
abstract = "Objective: Returns to the emergency department (ED) for pain or dehydration after adenotonsillectomy (T&A) are frequent. Attempts to associate the specific pain regimens with these visits have been unrevealing, suggesting a need to assess for other potential factors associated with readmission. Methods: A review of a 2:1 cohort matched by age, gender and payer status compared post-T&A patients who did not return ED for pain or dehydration within 21 days to those who returned. Factors investigated included patient demographics, comorbidities, medication regimen and the presence of postoperative telephone encounters. Patients returning to the ED were further assessed for rates of medication adherence. Results: 7493 patients underwent T&A during the period. Of these, 144 (1.9{\%}) returned for pain/dehydration. Comparison to 285 matched patients revealed an association between ED returns and Hispanic ethnicity (p < 0.001), Spanish language (p = 0.0002), and comorbid Down syndrome and ADHD (p = 0.011 in both). The incidence of parent telephone calls to the office was associated with ED returns (58.7 in the ED cohort, 28.4{\%} in non-ED cohort, p < 0.0001). On multivariable analysis, Hispanic ethnicity and phone calls were associated with ED returns (p < 0.0001 and p < 0.0001, respectively). Only 64.0{\%} of patients returning to the ED were adherent with postoperative pain regimens. Conclusions: While demographic factors may be associated with rate of ED returns for pain and dehydration, post-operative phone calls were most highly associated with returns. The majority of patients returning to the ED were non-adherent with recommended pain regimens, suggesting an opportunity to investigate medication adherence in all post-tonsillectomy patients.",
keywords = "Adenotonsillectomy complications, Adenotonsillectomy pain, Pediatric adenotonsillectomy",
author = "Lavin, {Jennifer M} and David Lehmann and Silva, {Astrid Leon} and Guangyu Bai and Ferdynand Hebal and Manworren, {Renee CB} and Stake, {Christine Elizabeth} and Karen Rychlik and Billings, {Kathleen R}",
year = "2019",
month = "8",
doi = "10.1016/j.ijporl.2019.04.038",
language = "English (US)",
volume = "123",
pages = "10--14",
journal = "International Journal of Pediatric Otorhinolaryngology",
issn = "0165-5876",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Variables associated with pediatric emergency department visits for uncontrolled pain in postoperative adenotonsillectomy patients

AU - Lavin, Jennifer M

AU - Lehmann, David

AU - Silva, Astrid Leon

AU - Bai, Guangyu

AU - Hebal, Ferdynand

AU - Manworren, Renee CB

AU - Stake, Christine Elizabeth

AU - Rychlik, Karen

AU - Billings, Kathleen R

PY - 2019/8

Y1 - 2019/8

N2 - Objective: Returns to the emergency department (ED) for pain or dehydration after adenotonsillectomy (T&A) are frequent. Attempts to associate the specific pain regimens with these visits have been unrevealing, suggesting a need to assess for other potential factors associated with readmission. Methods: A review of a 2:1 cohort matched by age, gender and payer status compared post-T&A patients who did not return ED for pain or dehydration within 21 days to those who returned. Factors investigated included patient demographics, comorbidities, medication regimen and the presence of postoperative telephone encounters. Patients returning to the ED were further assessed for rates of medication adherence. Results: 7493 patients underwent T&A during the period. Of these, 144 (1.9%) returned for pain/dehydration. Comparison to 285 matched patients revealed an association between ED returns and Hispanic ethnicity (p < 0.001), Spanish language (p = 0.0002), and comorbid Down syndrome and ADHD (p = 0.011 in both). The incidence of parent telephone calls to the office was associated with ED returns (58.7 in the ED cohort, 28.4% in non-ED cohort, p < 0.0001). On multivariable analysis, Hispanic ethnicity and phone calls were associated with ED returns (p < 0.0001 and p < 0.0001, respectively). Only 64.0% of patients returning to the ED were adherent with postoperative pain regimens. Conclusions: While demographic factors may be associated with rate of ED returns for pain and dehydration, post-operative phone calls were most highly associated with returns. The majority of patients returning to the ED were non-adherent with recommended pain regimens, suggesting an opportunity to investigate medication adherence in all post-tonsillectomy patients.

AB - Objective: Returns to the emergency department (ED) for pain or dehydration after adenotonsillectomy (T&A) are frequent. Attempts to associate the specific pain regimens with these visits have been unrevealing, suggesting a need to assess for other potential factors associated with readmission. Methods: A review of a 2:1 cohort matched by age, gender and payer status compared post-T&A patients who did not return ED for pain or dehydration within 21 days to those who returned. Factors investigated included patient demographics, comorbidities, medication regimen and the presence of postoperative telephone encounters. Patients returning to the ED were further assessed for rates of medication adherence. Results: 7493 patients underwent T&A during the period. Of these, 144 (1.9%) returned for pain/dehydration. Comparison to 285 matched patients revealed an association between ED returns and Hispanic ethnicity (p < 0.001), Spanish language (p = 0.0002), and comorbid Down syndrome and ADHD (p = 0.011 in both). The incidence of parent telephone calls to the office was associated with ED returns (58.7 in the ED cohort, 28.4% in non-ED cohort, p < 0.0001). On multivariable analysis, Hispanic ethnicity and phone calls were associated with ED returns (p < 0.0001 and p < 0.0001, respectively). Only 64.0% of patients returning to the ED were adherent with postoperative pain regimens. Conclusions: While demographic factors may be associated with rate of ED returns for pain and dehydration, post-operative phone calls were most highly associated with returns. The majority of patients returning to the ED were non-adherent with recommended pain regimens, suggesting an opportunity to investigate medication adherence in all post-tonsillectomy patients.

KW - Adenotonsillectomy complications

KW - Adenotonsillectomy pain

KW - Pediatric adenotonsillectomy

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U2 - 10.1016/j.ijporl.2019.04.038

DO - 10.1016/j.ijporl.2019.04.038

M3 - Article

C2 - 31054535

AN - SCOPUS:85064869691

VL - 123

SP - 10

EP - 14

JO - International Journal of Pediatric Otorhinolaryngology

JF - International Journal of Pediatric Otorhinolaryngology

SN - 0165-5876

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