Age as a Determinant to Select an Anesthesia Method for Tympanostomy Tube Insertion in a Pediatric Population

BACKGROUND AND OBJECTIVES: To evaluate the relationship between age and anesthesia method used for tympanostomy tube insertion (TTI) and to provide evidence to guide the selection of an appropriate anesthesia method in children. SUBJECTS AND METHODS: We performed a retrospective review of children under 15 years of age who underwent tympanostomy tube insertion (n=159) or myringotomy alone (n=175) under local or general anesthesia by a single surgeon at a university-based, secondary care referral hospital. Epidermiologic data between local and general anesthesia groups as well as between TTI and myringotomy were analyzed. Medical costs were compared between local and general anesthesia groups. RESULTS: Children who received local anesthesia were significantly older than those who received general anesthesia. Unilateral tympanostomy tube insertion was performed more frequently under local anesthesia than bilateral. Logistic regression modeling showed that local anesthesia was more frequently applied in older children (odds ratio=1.041) and for unilateral tympanostomy tube insertion (odds ratio=8.990). The cut-off value of age for local anesthesia was roughly 5 years. CONCLUSIONS: In a pediatric population at a single medical center, age and whether unilateral or bilateral procedures were required were important factors in selecting an anesthesia method for tympanostomy tube insertion. Our findings suggest that local anesthesia can be preferentially considered for children 5 years of age or older, especially in those with unilateral otitis media with effusion.

Benchmarking leading countries' accreditation programs for ambulatory healthcare organizations

Healthcare accreditation, which in the Republic of Korea is based on Article 58 of the Medical Service Act of July 2010, is an evaluation system designed to improve the quality of medical services and secure patient safety. Although ambulatory health organizations such as clinics comprise the majority of all health facilities, because they are not currently evaluated, securing quality and patient safety nationwide is not possible under the existing system. This article reviewed the accreditation programs of ambulatory health organizations in leading countries such as the United States and Australia in order to propose a successful model for Korea. The Accreditation Association for Ambulatory Health Care of the Unites States is a private, non-profit organization established in 1979. Similarly, Australian General Practice Accreditation Limited is a non-profit organization established in 1997 to deliver services to support general practices in Australia. Both are independent professional organizations and perform accreditation programs by a self-regulatory system. As healthcare quality improvement and accreditation have the characteristics of professional service activities, a self-regulatory approach rather than a government-controlled one, and process-oriented evaluation rather than structure-focused evaluation, are known to be effective. We expect an accreditation program for clinics in Korea to be established using a self-regulatory approach by an independent professional organization, not by the government, in the near future.