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Reference rate for post-tonsillectomy haemorrhage in Australia—A 2000–2020 national hospital morbidity database analysis. PLoS One 2022; 17:e0273320. [PMID: 36006990 PMCID: PMC9409536 DOI: 10.1371/journal.pone.0273320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/06/2022] [Indexed: 11/19/2022] Open
Abstract
This study aims to provide a national benchmark rate of post-tonsillectomy haemorrhage (PTH) in Australia. Using data from Australia’s National Hospital Morbidity Database (NHMD) from 1 July 2000 to 30 June 2020, we have conducted a nation-wide population-based study to estimate a reference rate of PTH. Outcomes of interest included the overall rate and time-trend of PTH, the relationship between PTH rates with age and gender as well as the epidemiology of tonsillectomy procedures. A total of 941,557 tonsillectomy procedures and 15,391 PTH episodes were recorded for the study period. Whilst the incidence of tonsillectomy procedures and the number of day-stay tonsillectomy procedures have increased substantially over time, the overall rate of PTH for all ages has remained relatively constant (1.6% [95% CI: 1.61 to 1.66]) with no significant association observed between the annual rates of PTH and time (year) (Spearman correlation coefficient, Rs = 0.24 (95% CI: -0.22 to 0.61), P = 0.3). However, the rate of PTH in adults (aged 15 years and over) experienced a statistically significant mild to moderate upward association with time (year) Rs = 0.64 (95% CI: 0.28 to 0.84), P = 0.003. Analysis of the odds of PTH using the risk factors of increasing age and male gender showed a unique age and gender risk pattern for PTH where males aged 20 to 24 years had the highest risk of PTH odds ratio 7.3 (95% CI: 6.7 to 7.8) compared to patients aged 1 to 4 years. Clinicians should be mindful of the greater risk of PTH in male adolescents and young adults. The NHMD datasets can be continually used to evaluate the benchmark PTH rate in Australia and to facilitate tonsillectomy surgical audit activities and quality improvement programs on a national basis.
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Xu B, Jin HY, Wu K, Chen C, Li L, Zhang Y, Gu WZ, Chen C. Primary and secondary postoperative hemorrhage in pediatric tonsillectomy. World J Clin Cases 2021; 9:1543-1553. [PMID: 33728298 PMCID: PMC7942054 DOI: 10.12998/wjcc.v9.i7.1543] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/27/2020] [Accepted: 01/21/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Tonsillectomy is the most common procedure for treatment of pediatric recurrent acute tonsillitis and tonsillar enlargement that contributes to obstructive sleep apnea hypopnea syndrome. Postoperative hemorrhage of tonsillectomy is a life-threatening complication.
AIM To identify the risk factors that may contribute to primary and secondary post-operative hemorrhage in pediatric tonsillectomy.
METHODS The clinical data from 5015 children, 3443 males and 1572 females, aged 1.92-17.08 years, with recurrent tonsillitis and/or tonsil hypertrophy who underwent tonsillectomy in our hospital from January 2009 to December 2018 were retrospectively collected. The variables including sex, age, time of onset, diagnosis, method of tonsillectomy, experience of surgeon, time when the surgery started and monthly average air temperature were abstracted. The patients with postoperative hemorrhage were classified into two groups, the primary bleeding group and the secondary bleeding group, and their characteristics were compared with those of the nonbleeding group separately. Statistical analysis was performed by chi-square test with SPSS 20.
RESULTS Ninety-two patients had post-tonsillectomy hemorrhage, and the incidence rate of post-tonsillectomy hemorrhage was 1.83%. The mean age was 5.75 years. Cases of primary hemorrhage accounted for approximately 33.70% (31/92), and cases of secondary hemorrhage occurred in 66.30% (61/92). The rate of reoperation for bleeding was 0.92%, and the rate of rehospitalization for bleeding was 0.88% in all patients. Multiple hemostasis surgery was performed in 6.52% (3/46) of patients. The method of tonsillectomy (coblation tonsillectomy) and experience of the surgeon (junior surgeon with less than 5 years of experience) were significantly associated with primary hemorrhage (χ2 = 5.830, P = 0.016, χ2= 6.621, P = 0.010, respectively). Age (over 6 years old) and time of onset (more than a 1-year history) were significantly associated with secondary hemorrhage (χ2= 15.242, P = 0.000, χ2=4.293, P = 0.038, respectively). There was no significant difference in sex, diagnosis, time when the surgery started or monthly average air temperature. There was a significant difference in the intervention measures between the primary bleeding group and the secondary bleeding group (χ2= 10.947, P = 0.001). The lower pole and middle portion were the common bleeding sites, followed by the upper pole and palatoglossal arch.
CONCLUSION The incidence rate of post-tonsillectomy hemorrhage is low. Coblation tonsillectomy and less than 5 years’ experience of surgeon contribute to the tendency for primary hemorrhage. Age and time of onset are responsible for secondary hemorrhage.
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Affiliation(s)
- Bin Xu
- Department of Otorhinolaryngology-Head and Neck Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou 310052, Zhejiang Province, China
| | - Hai-Yan Jin
- Department of Anesthesiology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou 310052, Zhejiang Province, China
| | - Ke Wu
- Department of Operating Room, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou 310052, Zhejiang Province, China
| | - Cao Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou 310052, Zhejiang Province, China
| | - Li Li
- Department of Operating Room, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou 310052, Zhejiang Province, China
| | - Yang Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou 310052, Zhejiang Province, China
| | - Wei-Zhong Gu
- Department of Pathology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou 310052, Zhejiang Province, China
| | - Chao Chen
- Department of Radiology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou 310052, Zhejiang Province, China
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Tran AHL, Horne RSC, Rimmer J, Nixon GM. Adenotonsillectomy for paediatric sleep disordered breathing in Australia and New Zealand. Sleep Med 2020; 78:101-107. [PMID: 33421669 DOI: 10.1016/j.sleep.2020.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/09/2020] [Accepted: 12/09/2020] [Indexed: 11/30/2022]
Abstract
AIMS To review the contributions of Australian and New Zealand research on adenotonsillectomy for the treatment of symptoms of obstructed breathing during sleep (sleep disordered breathing, SDB) in children. METHODS A search of the scientific literature was conducted using the MEDLINE (Ovid), PubMed and Scopus databases in August 2020. The following search string was used: (tonsillectomy OR adenoidectomy OR adenotonsillectomy) AND (paediatric OR child) AND (Australia OR New Zealand). A focused internet search was additionally conducted on Google to identify grey literature. RESULTS Researchers from Australia and New Zealand have made important contributions to the understanding and improvement of adenotonsillectomy (AT), including its epidemiology, cost, surgical techniques and peri-operative safety. Rates of AT have fluctuated over the years, becoming the most common paediatric surgery today, with SDB becoming the most common indication. Research in Australia and New Zealand has also focussed on the impact of AT on quality of life, and behaviour, neurocognition and cardiovascular sequelae. CONCLUSIONS Australian and New Zealand researchers have played a significant role in understanding the epidemiology and improving the safety of AT. There are promising directions in research still to come, including better understanding of the reasons for geographical variation in surgery rates, developing more efficient pre-operative risk assessment tools and alternative treatment options for mild OSA.
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Affiliation(s)
- Aimy H L Tran
- Department of Paediatrics, Monash University and The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
| | - Rosemary S C Horne
- Department of Paediatrics, Monash University and The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia
| | - Joanne Rimmer
- Department of Otolaryngology, Head and Neck Surgery, Monash Health, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia
| | - Gillian M Nixon
- Department of Paediatrics, Monash University and The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia; Melbourne Children's Sleep Centre, Monash Children's Hospital, Melbourne, Australia.
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Vyskocil E, Baumgartner WD, Ch. Grasl M, Grasl S, Arnoldner C, Steyrer J, Erovic BM. Post-tonsillectomy hemorrhage: cost-benefit analysis of prolonged hospitalization. Acta Otolaryngol 2020; 140:597-602. [PMID: 32281464 DOI: 10.1080/00016489.2020.1746829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Prolonged hospitalization after tonsillectomy up to three nights was implemented to decrease mortality due to post-tonsillectomy hemorrhage.Aims: To assess if extension of postoperative inpatient observation time from one to three nights results in potential benefits following tonsillectomy.Subjects and methods: Patients who stayed only one night post-tonsillectomy between 1994 and 2006 (Group A) were compared to 1570 patients who stayed three nights postoperatively between 2008 and 2016 (Group B). Complication rate and expense of hospitalization were compared.Results: Published data show that 114 (1.78%) out of 6400 patients in group A had post-tonsillectomy hemorrhage. In this patient group 75.4% (n = 86) of all bleedings occurred after discharge from hospital. However, in group B post-tonsillectomy hemorrhage occurred in 70 (4.5%) and of those only 0.38% (n = 6) developed bleeding episodes on the second or third postoperative day (POD). As observed in group A, the majority of hemorrhage (n = 57; 81.4%) was observed after discharge. Cost analysis reveals a difference of approximately 6 million €for all 32 ENT departments per year in Austria.Conclusions and significance: Extending postoperative hospitalization from one to three nights reveals no benefit after tonsillectomy. Comparison reveals substantial increase of costs for an extended 3 nights inpatient stay.
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Affiliation(s)
- Erich Vyskocil
- Department of Otorhinolaryngology, Head Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Wolf-Dieter Baumgartner
- Department of Otorhinolaryngology, Head Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Matthaeus Ch. Grasl
- Department of Otorhinolaryngology, Head Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Stephan Grasl
- Department of Otorhinolaryngology, Head Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Christoph Arnoldner
- Department of Otorhinolaryngology, Head Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Johannes Steyrer
- Interdisciplinary Institute for Management and Organisational Behaviour, Vienna, Austria
| | - Boban M. Erovic
- Department of Otorhinolaryngology, Head Neck Surgery, Medical University of Vienna, Vienna, Austria
- Institute for Head and Neck Diseases, Evangelical Hospital Vienna, Vienna, Austria
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Optimising care in an age of austerity: patient-reported outcome measures in paediatric ENT, journal bias, tonsillectomy and endoscopic ear surgery. The Journal of Laryngology & Otology 2017; 132:1. [PMID: 29286000 DOI: 10.1017/s0022215117002584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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