Characterizing a Department's Transition to Intracapsular Tonsillectomy: A Mixed Methods Analysis.

Abstract

Despite many reports of reduced postoperative complications and equivalent long-term outcomes compared to total tonsillectomy (TT), there is still limited adoption of intracapsular tonsillectomy (IT). Changing surgical techniques can be challenging, particularly for common procedures that already have good outcomes. To examine the barriers to adopting IT, we performed a mixed methods study of an otolaryngology department's transition from TT to IT, describing the timeline, postoperative outcomes, and surgeon-specific motivators. We used an explanatory sequential mixed methods model. Demographic and surgical data for all pediatric patients undergoing tonsillectomy between January 1, 2017 and December 31, 2022 at a single institution were included. Charts of patients who returned to the hospital within 30 days of tonsillectomy were reviewed. We then conducted semi-structured interviews to qualitatively evaluate surgeon-specific motivators for transitioning to IT. Over 6 years, 13,899 patients who underwent tonsillectomy met inclusion. The proportion of IT increased from 2.3% in 2017 to 80.8% in 2022. While 10% (n = 994) of TT patients returned to the ED within 30 days of tonsillectomy, only 3.1% (n = 133) of IT patients returned. Five themes were identified in the qualitative analysis, grouped into two motivating factors (Data Transparency and Individual Surgeon Experience) and three transition concerns (Interaction with Patient Families, Training and Skill Acquisition, and Impact on Partners). We define the prominent agents of surgical change for IT. Transition to newer, safer techniques is scalable in the setting of departmental data transparency and a culture that promotes best outcomes.