2017 HSC Section 2 - Practice Management

Otolaryngology–Head and Neck Surgery 155(2)

Data Analysis Data was managed and analyzed with SPSS 17 for Windows (IBM Corp, Armonk, New York). Descriptive statistics were used to summarize demographic characteristics and the risks and benefits mentioned and recalled. Nonparametric tests (results were not normally distributed)—including Wilcoxon signed ranks, Kruskal-Wallis, and Mann-Whitney U tests— were used depending on how many independent groups were included in the analyses to assess differences in recall across the various identified predictors. Sample size was assessed through analysis with the independent variable consisting of the most groups (ie, the most stringent of the analyses conducted)—specifically, 3 degrees of freedom, power of 0.95, a set at 0.05, and a medium estimated effect size of 0.5 indicated that the sample required at least 69 participants. Over a 1-year period, 131 parents were enrolled in this study, of whom 42 did not complete the follow-up interview and 5 video recordings were unable to be coded due to tech- nical problems. This resulted in a final sample of 84 partici- pants. No significant differences were found in any of the demographic factors between those who completed the study and those who did not complete the study. The majority of participants were mothers (81.0%) between the ages of 19 and 44 years (mean 6 SD, 33.23 6 5.07); fathers (19.0%) were between 19 and 51 years old (35.25 6 5.91). The mean age of children was 33.56 6 15.20 months (range, 9-60), and about half (59.5%) were boys. Most parents were married (70.2%) and Caucasian (89.3%). Seventeen (20.2%) participant children had under- gone surgery, and 13 (15.5%) parents reported that other chil- dren in the family had previous surgery. Of the 84 families, 26 (31.0%) had 2 parents present at the consultation visit. A summary of the demographic details is presented in Table 1 . Three fellowship-trained pediatric otolaryngologists, who ranged in age from 37 to 47 years, conducted the consulta- tion appointments. Two were men, 1 was a woman, and all were in a salaried academic practice. All 3 completed their otolaryngology–head and neck surgery residency in Canada, with fellowship training in the United States (n = 2) and Australia (n = 1). Medical trainees were present in 33 video recordings (39.3%), and 1 of 2 female nurses was involved in 49 (58%) visits. Risks and Benefits Mentioned The specific benefits and risks mentioned during the consul- tation and those recalled by the participants for adenotonsil- lectomy and tympanostomy tube insertion are shown in Tables 2 and 3 . The rare benefits and risks documented in the literature (eg, death from bleeding) but not mentioned during the consultations are not included in the tables. Across all procedures, the most common benefits of sur- gery mentioned were the reduced number of infections (otitis media or tonsillitis, 37%) and the reduced number of Results Participants

Table 2. Risks and Benefits Mentioned and Recalled Associated with Adenotonsillectomy.

Mentioned at 2-wk Follow-up Interview

Mentioned during Consultation

Benefits of surgery Better breathing

18

16

Growth spurt

6 1 1 1 4

5 1 0 0 2

Improve attention issues a Improved cognitive/learning a

Fewer colds

Reduced nasal discharge/secretion b

Improved eating/appetite c

2

6

Reduced apneas a Improved sleep

2

1 9 0

15

Improved daytime energy a Reduced number of infections a Reduced number of oral antibiotics a Reduced days of daycare/school/ work missed a

1

31 15

27

2 0

1

Improved speech/voice a,c Improved quality of life a

1

2

7 1

7 0

Prevents long term comorbidities a

Risks of surgery

General anesthesia Bleeding/hemorrhage

35 36 14 33

17 26

Bad breath

1 2 0 0 5 1 0 0

Discomfort/pain Vomiting/nausea a

5 6

Fever

Time off from school and activities Regrowth of adenoids over time b

18

4

Dehydration

17

Reduce oral intake a

9

Readmission a

30 14

11

Need for blood transfusion a

0

oral antibiotics required postsurgery (18%). Specific to ade- notonsillectomy, better breathing (21%) and improved sleep (18%) were most commonly mentioned by the surgeons. Most common risks mentioned during the consultation were risk of general anesthesia (42%) and readmission (36%). For adeno/tonsillectomy, bleeding/hemorrhage (43%) and discomfort/pain (39%) were most commonly mentioned. Risk and Benefits Recalled The most commonly recalled benefits were reduced infections (32%) and better breathing (19%). The most com- monly recalled risks were risk of general anesthesia (20%) and bleeding/hemorrhage (31%). Specific to tympanostomy a Tonsillectomy only. b Adenoidectomy only. c Gray shading indicates that risk or benefit was mentioned by more parents than those who were told in the consultation visit about it.

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