Auris Nasus Larynx. 2026 Sep 8:S0385-8146(26)00123-9. doi: 10.1016/j.anl.2026.08.003. Online ahead of print.
ABSTRACT
OBJECTIVE: Practices in pediatric adenoid and tonsil surgery may vary substantially across healthcare systems, especially where institutional resources, perioperative support, and access to surgical technologies differ. However, the factors underlying this variability in routine practice remain insufficiently characterized. This study evaluated surgical practice patterns and decision-making factors among otorhinolaryngology (ENT) physicians in Türkiye, with particular emphasis on institutional, safety-related, technological, and medicolegal determinants.
METHODS: This nationwide, descriptive, cross-sectional, web-based survey used a structured questionnaire distributed through Google Forms. ENT physicians actively practicing in Türkiye were invited through professional platforms. The survey assessed demographic characteristics, surgical procedures and techniques, indications for surgery, reported complications, institutional and safety-related factors, and perceived trends in surgical frequency. Descriptive statistical analyses were performed.
RESULTS: A total of 213 ENT physicians were included. Most participants were male (59.2%), had ≥ 20 years of professional experience (55.4%), and worked in private healthcare settings (48.4%). The most frequently performed procedure was adenoidectomy combined with extracapsular tonsillectomy (57.3%). Traditional curettage and cold steel techniques were preferred by 67.1% of participants, and advanced technologies were used less frequently. The predominant indications were upper airway obstruction (95.8%) and recurrent infections (78.4%), consistent with guideline-supported indications. Overall, 88.3% of participants reported encountering at least one perioperative or postoperative complication, most commonly secondary hemorrhage. Institutional readiness, safety concerns, perioperative support, and medicolegal issues were identified as important determinants of surgical decision-making. A perceived decrease in surgical frequency was reported by 64.8% of participants.
CONCLUSION: Decisions about pediatric adenoid and tonsil surgery in routine practice are shaped by guideline-supported clinical indications as well as institutional readiness, access to pediatric perioperative support, technology availability, reimbursement-related barriers, and medicolegal concerns. Although the findings originate from Türkiye, they may be relevant to other healthcare systems where pediatric airway surgery is performed in institutions with variable resources and support infrastructure. Standardized perioperative protocols and institutional capacity building may help reduce practice variability and improve patient safety.
PMID:42711223 | DOI:10.1016/j.anl.2026.08.003
