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Data Analysis
Data was managed and analyzed with SPSS 17 for Windows
(IBM Corp, Armonk, New York). Descriptive statistics were
used to summarize demographic characteristics and the risks
and benefits mentioned and recalled. Nonparametric tests
(results were not normally distributed)—including Wilcoxon
signed ranks, Kruskal-Wallis, and Mann-Whitney
U
tests—
were used depending on how many independent groups were
included in the analyses to assess differences in recall across
the various identified predictors. Sample size was assessed
through analysis with the independent variable consisting of
the most groups (ie, the most stringent of the analyses
conducted)—specifically, 3 degrees of freedom, power of
0.95,
a
set at 0.05, and a medium estimated effect size of
0.5 indicated that the sample required at least 69 participants.
Results
Participants
Over a 1-year period, 131 parents were enrolled in this
study, of whom 42 did not complete the follow-up interview
and 5 video recordings were unable to be coded due to tech-
nical problems. This resulted in a final sample of 84 partici-
pants. No significant differences were found in any of the
demographic factors between those who completed the
study and those who did not complete the study.
The majority of participants were mothers (81.0%)
between the ages of 19 and 44 years (mean
6
SD, 33.23
6
5.07); fathers (19.0%) were between 19 and 51 years old
(35.25
6
5.91). The mean age of children was 33.56
6
15.20 months (range, 9-60), and about half (59.5%) were
boys. Most parents were married (70.2%) and Caucasian
(89.3%). Seventeen (20.2%) participant children had under-
gone surgery, and 13 (15.5%) parents reported that other chil-
dren in the family had previous surgery. Of the 84 families,
26 (31.0%) had 2 parents present at the consultation visit. A
summary of the demographic details is presented in
Table 1
.
Three fellowship-trained pediatric otolaryngologists, who
ranged in age from 37 to 47 years, conducted the consulta-
tion appointments. Two were men, 1 was a woman, and all
were in a salaried academic practice. All 3 completed their
otolaryngology–head and neck surgery residency in Canada,
with fellowship training in the United States (n = 2) and
Australia (n = 1). Medical trainees were present in 33 video
recordings (39.3%), and 1 of 2 female nurses was involved
in 49 (58%) visits.
Risks and Benefits Mentioned
The specific benefits and risks mentioned during the consul-
tation and those recalled by the participants for adenotonsil-
lectomy and tympanostomy tube insertion are shown in
Tables 2 and 3
. The rare benefits and risks documented in
the literature (eg, death from bleeding) but not mentioned
during the consultations are not included in the tables.
Across all procedures, the most common benefits of sur-
gery mentioned were the reduced number of infections
(otitis media or tonsillitis, 37%) and the reduced number of
oral antibiotics required postsurgery (18%). Specific to ade-
notonsillectomy, better breathing (21%) and improved sleep
(18%) were most commonly mentioned by the surgeons.
Most common risks mentioned during the consultation were
risk of general anesthesia (42%) and readmission (36%).
For adeno/tonsillectomy, bleeding/hemorrhage (43%) and
discomfort/pain (39%) were most commonly mentioned.
Risk and Benefits Recalled
The most commonly recalled benefits were reduced
infections (32%) and better breathing (19%). The most com-
monly recalled risks were risk of general anesthesia (20%)
and bleeding/hemorrhage (31%). Specific to tympanostomy
Table 2.
Risks and Benefits Mentioned and Recalled Associated
with Adenotonsillectomy.
Mentioned
during
Consultation
Mentioned
at 2-wk
Follow-up
Interview
Benefits of surgery
Better breathing
18
16
Growth spurt
6
5
Improve attention issues
a
1
1
Improved cognitive/learning
a
1
0
Fewer colds
1
0
Reduced nasal discharge/secretion
b
4
2
Improved eating/appetite
c
2
6
Reduced apneas
a
2
1
Improved sleep
15
9
Improved daytime energy
a
1
0
Reduced number of infections
a
31
27
Reduced number of oral antibiotics
a
15
2
Reduced days of daycare/school/
work missed
a
1
0
Improved speech/voice
a,c
1
2
Improved quality of life
a
7
7
Prevents long term comorbidities
a
1
0
Risks of surgery
General anesthesia
35
17
Bleeding/hemorrhage
36
26
Bad breath
14
1
Discomfort/pain
33
2
Vomiting/nausea
a
5
0
Fever
6
0
Time off from school and activities
18
5
Regrowth of adenoids over time
b
4
1
Dehydration
17
0
Reduce oral intake
a
9
0
Readmission
a
30
11
Need for blood transfusion
a
14
0
a
Tonsillectomy only.
b
Adenoidectomy only.
c
Gray shading indicates that risk or benefit was mentioned by more parents
than those who were told in the consultation visit about it.
Otolaryngology–Head and Neck Surgery 155(2)
83