Preoperative coagulation screening for adenotonsillectomy: a review and comparison of current physician practices.

Abstract

To determine the current practice of pediatric otolaryngologists on a national level and general otolaryngologists on a regional level regarding preoperative coagulation screening prior to adenotonsillectomy. A five-question survey of members of the American Society of Pediatric Otolaryngology (ASPO) and the Massachusetts Society of Otolaryngology-Head and Neck Surgery (MSO-HNS). Surveys results were analyzed to determine current preoperative screening practices relative to awareness of screening recommendations published in the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) 1999 Clinical Indicators Compendium. The survey response rate was 27 percent (54/190) and 29 percent (76/260) for MSO-HNS and ASPO members, respectively. In patients with no known bleeding risk, 21 percent of respondents continue to obtain coagulation screening including, at a minimum, a partial thromboplastin time and a prothrombin time. MSO-HNS respondents reported ordering more preoperative coagulation studies than did ASPO respondents (35% vs 10%). Interestingly awareness of the AAO-HNS consensus statement was similar between the two groups and did not impact screening practices. The survey results indicate a discrepancy between current practice relative to pre-adenotonsillectomy coagulation screening and the recommendations of the AAO-HNS 1999 consensus statement.