Adenotonsillectomy in Paediatrics

Key words: Adenotonsillectomy, Organizational/clinical change, Guidelines implementation Epidemiology of adenotonsillary surgery

Background - Adenotonsillectomy is among the most frequent surgical intervention in paediatric age. Although the availability of several recommendations on the clinical and organizational approach to be followed, there is evidence of an important variability, both at the national, and at the regional level as well within local districts. The Piedmont Regional Health Authority has addressed the issue of the quality of adenotonsillary surgery in paediatrics by involving several professionals with the aim of improving safety and overall quality of the clinical and organizational adenotonsillary pathway.
Purpose - Aim of this work is to describe the results that have characterised the last thirteen years on the activities undertaken by health professionals and the health local government division in the Piedmont Region on the adenotonsillary surgery.
Materials and methods - The whole process is reported by describing the epidemiological situation and the variability of adenotonsillary surgery from 1998 to 2015 and by describing the clinical-organizational choices that have contributed to the observed change.
Results and conclusions - Despite of a continuous decrease in the number of interventions, that has reduced from about 126 to 50 surgeries per 10,000 children between 1998 and 2015, an important variability among local health districts is still present. Part of this reduction seems to be due to the prominent role of the Regional Health Authority, which has established a multidisciplinary professional group, facilitated the dissemination and adaptation of the national guidelines to the Piedmont area reality and has promoted several trainings. But above all, such reduction seems to be attributable to the innovative multi- disciplinary approach used, which has allowed the involved professionals to be the real leaders of the observed change.