Adherence to American Academy of Otolaryngology–Head and Neck Surgery Clinical Practice Guidelines: A Systematic Review

Marisa A. Ryan, Grace R. Leu, Emily F. Boss, Eileen M. Raynor, Jonathan M. Walsh

Research output: Contribution to journalReview articlepeer-review


Objective: Clinical practice guidelines synthesize and disseminate the best available evidence to guide clinical decisions and increase high-quality care. Since 2004, the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF) has published 16 guidelines. The objective of this review was to evaluate clinicians’ adherence to these guidelines’ recommendations as measured in the literature. Data Sources: We searched PubMed, Embase, and Web of Science on August 29, 2019, for studies published after June 1, 2004. Review Methods: We systematically identified peer-reviewed studies in English that reported clinician adherence to AAO-HNSF guideline recommendations. Two authors independently reviewed and abstracted study characteristics, including publication date, population, sample size, guideline adherence, and risk of bias. Results: The search yielded 385 studies. We excluded 331 studies during title/abstract screening and 32 more after full-text review. The remaining 22 studies evaluated recommendations from 8 of the 16 guidelines. The Otitis Media with Effusion, Polysomnography, Tonsillectomy, and Sinusitis guidelines were studied most. Study designs included retrospective chart reviews (7, 32%), clinician surveys (7, 32%), and health care database analyses (8, 36%). Studies reported adherence ranging from 0% to 99.8% with a mean of 56%. Adherence varied depending on the recommendation evaluated, type of recommendation, clinician type, and clinical setting. Adherence to the polysomnography recommendations was low (8%-65.3%). Adherence was higher for the otitis media with effusion (76%-90%) and tonsillectomy (43%-98.9%) recommendations. Conclusions: Adherence to recommendations in the AAO-HNSF guidelines varies widely. These findings highlight areas for further guideline dissemination, research about guideline adoption, and quality improvement.

Original languageEnglish (US)
Pages (from-to)626-644
Number of pages19
JournalOtolaryngology - Head and Neck Surgery (United States)
Issue number4
StatePublished - Oct 1 2020


  • clinical practice guidelines
  • implementation
  • otolaryngology
  • quality improvement
  • quality metrics

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology


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