1
|
Zhao J, Lei Y, Hu N, Xia L, Zeng L, Zhang Y, Qin W. Management of massive cerebral infarction as a complication of post-tonsillectomy and analysis of the risk factors: a case report. BMC Neurol 2023; 23:4. [PMID: 36604637 PMCID: PMC9814409 DOI: 10.1186/s12883-022-03040-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 12/20/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The majority of postoperative complications of tonsillectomy are bleeding. However, massive cerebral infarction following haemostasis is a very rare and serious complication and has rarely been reported clinically. CASE PRESENTATION We performed a left tonsillectomy on a patient with chronic tonsillitis. After that, active bleeding was found under the tonsillar fossa, so an exploratory hypopharyngeal haemostasis was performed. However, the bleeding worsened intraoperatively, so the patient was converted to a cervical angiographic embolization. The interventional procedure was completed successfully without an ectopic embolic event. After the procedure, the patient was transferred to the intensive care unit (ICU) and was diagnosed with acute massive cerebral infarction in the left cerebral hemisphere after awakening symptoms combined with cranial computed tomography angiography (CTA) results. Symptomatic treatment such as sedation and analgesia, dehydration to lower intracranial pressure, and maintenance of respiratory and circulatory stability was then administered. After treatment, the patient's condition stabilized and he was transferred to the rehabilitation physiotherapy unit for rehabilitation. CONCLUSION Post-tonsillectomy haemorrhage can be augmented with a carotid arteriogram to clarify whether the tonsillar fossa is at a safe distance from the posterior internal carotid artery. Furthermore, interventional haemostasis can also be performed as early as possible to reduce the incidence of complications in cases of persistent post-tonsillectomy bleeding.
Collapse
Affiliation(s)
- Jinghao Zhao
- Department of Intervention center, Suining central hospital, No. 127 Desheng West Road, Chuanshan District, Sichuan 629000 Suining, China
| | - Yubo Lei
- Department of Intervention center, Suining central hospital, No. 127 Desheng West Road, Chuanshan District, Sichuan 629000 Suining, China
| | - Na Hu
- Department of Radiology, Suining Central Hospital, 629000 Suining, Sichuan China
| | - Lang Xia
- Department of Intervention center, Suining central hospital, No. 127 Desheng West Road, Chuanshan District, Sichuan 629000 Suining, China
| | - Liyang Zeng
- Department of Intervention center, Suining central hospital, No. 127 Desheng West Road, Chuanshan District, Sichuan 629000 Suining, China
| | - Yongheng Zhang
- Department of Cardiovascular surgery, Suining central hospital, Suining central hospital, No. 127 Desheng West Road, Chuanshan District, Sichuan 629000 Suining, China
| | - Wei Qin
- Department of Intervention center, Suining central hospital, No. 127 Desheng West Road, Chuanshan District, Sichuan 629000 Suining, China
| |
Collapse
|
2
|
Shuaibu I, Usman M, Ajiya A, Chitumu D, Mohammed I, Abdullahi H, Adebola S, Adamu A. Adenoid and tonsil hypertrophy in Zaria, North Western Nigeria: Review of clinical presentation and surgical outcome. JOURNAL OF WEST AFRICAN COLLEGE OF SURGEONS 2022; 12:23-27. [PMID: 36203928 PMCID: PMC9531741 DOI: 10.4103/jwas.jwas_71_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 04/28/2022] [Indexed: 11/04/2022]
|
3
|
Yang CJ, Bottalico D, Philips K, DeSilva A, Cheung V, Joels J, Cruz C, Hametz PA. Improving the Pediatric Floor Discharge Process Following Tonsillectomy. Laryngoscope 2021; 132:225-233. [PMID: 34236088 DOI: 10.1002/lary.29745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/19/2021] [Accepted: 06/29/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVES/HYPOTHESIS Over 300,000 tonsillectomies are performed nationwide every year. In 2017, half of children undergoing tonsillectomy at our institution were admitted to the pediatric floor, with only 10.4% being discharged before 11 AM on postoperative day 1 (POD1). Our primary objective was to increase the percentage of patients discharged before 11 AM on POD1 to at least 50% within 1 year. STUDY DESIGN Prospective observational (quality improvement). METHODS A multidisciplinary quality improvement (QI) team was assembled. The primary outcome was "timely discharges," defined as percentage of patients discharged before 11 AM on POD1; secondary outcomes were percentage of patients discharged before 1 PM and mean length of stay (hours). Seven-day readmission rate served as our balancing measure. Prior year data served as baseline. A process map, Ishikawa diagram, and Pareto chart were utilized to identify specific target areas for improvement. Key interventions included announcement of our initiative, an electronic health record-based handoff text prompt, discharge checklist, automated discharge instructions, encouragement to place discharge orders by 9 AM and implementation of early POD1 rounds. Data were collected on a biweekly basis and the primary and secondary outcomes were plotted on control charts and analyzed using rules for special cause variation. RESULTS Within 12 months, POD1 discharges before 11 AM and before 1 PM increased to 44.9% and 83.8%, respectively, with sustained improvement for the first 6 months of the subsequent year. Mean length of stay decreased, and 7-day readmission rates were unchanged. CONCLUSIONS By understanding the factors influencing timely POD1 discharges after tonsillectomy, key interventions were implemented to achieve an increase in timely discharges. LEVEL OF EVIDENCE III Laryngoscope, 2021.
Collapse
Affiliation(s)
- Christina J Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, U.S.A.,Albert Einstein College of Medicine, Bronx, New York, U.S.A
| | - Danielle Bottalico
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, U.S.A
| | - Kaitlyn Philips
- Albert Einstein College of Medicine, Bronx, New York, U.S.A.,Department of Pediatrics, The Children's Hospital at Montefiore, Bronx, New York, U.S.A
| | - Alison DeSilva
- Department of Pediatrics, The Children's Hospital at Montefiore, Bronx, New York, U.S.A
| | - Victoria Cheung
- Department of Pediatrics, The Children's Hospital at Montefiore, Bronx, New York, U.S.A
| | - Joanna Joels
- Department of Pediatrics, The Children's Hospital at Montefiore, Bronx, New York, U.S.A
| | - Carlos Cruz
- Albert Einstein College of Medicine, Bronx, New York, U.S.A
| | - Patricia A Hametz
- Albert Einstein College of Medicine, Bronx, New York, U.S.A.,Department of Pediatrics, The Children's Hospital at Montefiore, Bronx, New York, U.S.A
| |
Collapse
|
4
|
Cheung JL, Dreyer C, Ranjitkar S. Opening up on airways: the purported effect of nasorespiratory obstruction on dentofacial growth. Aust Dent J 2021; 66:358-370. [PMID: 34031885 DOI: 10.1111/adj.12858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 12/26/2022]
Abstract
Nasorespiratory obstruction has been purported to influence dentofacial growth adversely. This has sparked considerable debate for decades with a resurgence in interest in 'airway friendly orthodontics' among both general and specialist dental practitioners. This critical review aims to evaluate the current literature relating to two questions: does nasorespiratory obstruction alter dentofacial growth, and does early intervention targeted at alleviating nasorespiratory obstruction improve dentofacial growth? The strength of association between nasorespiratory obstruction, mouth breathing and a long face is weak. The common methodological flaws in research include unblinded and cross-sectional study designs, a lack of adequate controls, inadequate follow-up, subjective assessments and inadequate statistical power. Vertical dentofacial growth has a strong genetic influence, which implies a relatively minor contribution of environmental factors including airway obstruction. The current evidence does not support recommending procedures, such as adenotonsillectomy and maxillary expansion, with the singular aim of negating a hyperdivergent (vertical) dentofacial growth pattern. In light of low-quality evidence, both the World Health Organization guidelines and ethical principles dictate that greater emphasis is placed on avoiding harm and wastage of resources over alternative options. These findings call for quality improvement in undergraduate and postgraduate curricula and continuing professional development for health professionals.
Collapse
Affiliation(s)
- J-Ls Cheung
- Private Practice, Melbourne, Victoria, Australia
| | - C Dreyer
- Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - S Ranjitkar
- Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia.,Department of Dentistry and Oral Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| |
Collapse
|
5
|
Abstract
OBJECTIVES To determine the frequency of respiratory complications in children admitted to the ICU after adenotonsillectomy and to identify factors associated with the risk of respiratory complications in this cohort. DESIGN Retrospective observational study. SETTING PICU. PATIENT POPULATION All children admitted to the ICU following adenotonsillectomy from September 30, 2009, to March 30, 2014. MEASUREMENTS AND MAIN RESULTS Of the 165 children included in the study, 150 (91%) received no respiratory support other than oxygen in the first 2 hours postoperatively. Of the 15 who required support following 2 hours, 14 required nasopharyngeal airways, one required invasive mechanical ventilation, and seven required supplemental oxygen for more than 2 hours. None of the children who received respiratory support for less than 2 hours required subsequent ICU level care. When comparing those who received support for more than 2 hours to those who did not, there were no differences in clinical characteristics except that those who received support were more likely to have chronic neurologic disease including autism, seizures, or cerebral palsy (odds ratio, 3.7; 95% CI, 1.1-11.9; p = 0.04). Intraoperative events were not predictive of need for respiratory support. Most of the children (n = 117/165 or 71%) had sleep studies preoperatively. Abnormal sleep studies (apnea-hypopnea index > 20 [n = 68] or oxygen saturation nadir < 80% [n = 48]) were not associated with need for postoperative respiratory support. CONCLUSIONS Most children admitted to the ICU following adenotonsillectomy in this population required no support after 2 hours. Preoperative factors such as obesity and abnormal sleep studies were not predictive of need for postoperative respiratory support. Need for respiratory support at 2 hours may be a useful criterion for need for ICU level care in this population.
Collapse
|
6
|
Chung SD, Lin HC, Wu CS, Kao LT, Hung SH. A tonsillectomy increased the risk of chronic rhinosinusitis among children: A three-year follow-up study. Int J Pediatr Otorhinolaryngol 2016; 91:82-85. [PMID: 27863647 DOI: 10.1016/j.ijporl.2016.09.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/16/2016] [Accepted: 09/29/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The study aimed to estimate the risk of developing chronic rhinosinusitis (CRS) among children who had undergone a tonsillectomy by utilizing a cohort study based on a population-based database. METHODS Data for this retrospective cohort study were sourced from the Taiwan "Longitudinal Health Insurance Database 2000". We included 202 children who had undergone a tonsillectomy as the study group and 2020 sex- and age-matched children as the comparison group. We used stratified Cox proportional hazard regressions to calculate the hazard ratio (HR) and its corresponding 95% confidence interval (CI) for CRS during the 3-year follow-up period. RESULTS Of 2222 sampled children, the incidence rate of CRS during the 3-year follow-up period was 3.2 (95% CI = 2.0-4.8) 1000 person-years; 18.2 (95% CI = 9.1-32.5) per 1000 person-years and 1.7 (95% CI = 0.8-3.0) per 1000 person-years for the study and comparison group, respectively. The stratified Cox proportional analysis showed that the adjusted hazard ratio for CRS during the 3-year follow-up period was 8.28 (95% CI = 3.24-21.16) for children who had undergone a tonsillectomy than comparison patients. CONCLUSIONS We demonstrated that the risk of developing CRS is significantly increased among children who have undergone a tonsillectomy.
Collapse
Affiliation(s)
- Shiu-Dong Chung
- Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Graduate Program in Biomedical Informatics, College of Informatics, Yuan-Ze University, Chung-Li, Taiwan; Sleep Research Center, Taipei Medical University, Taipei, Taiwan
| | - Herng-Ching Lin
- Sleep Research Center, Taipei Medical University, Taipei, Taiwan
| | - Chuan-Song Wu
- Department of Otolaryngology, Taipei City Hospital, Taipei, Taiwan
| | - Li-Ting Kao
- Graduate Institute of Life Science, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Han Hung
- Department of Otolaryngology, Taipei Medical University Hospital, Taipei, Taiwan; Department of Otolaryngology, School of Medicine, Taipei Medical University, Taipei, Taiwan.
| |
Collapse
|
7
|
Ameye SA, Owojuyigbe AM, Adeyemo A, Adenekan AT, Ouche S. Pediatric Adenotonsillectomy in a Low Resource Setting: Lessons and Implications. Niger J Surg 2016; 22:77-80. [PMID: 27843269 PMCID: PMC5013746 DOI: 10.4103/1117-6806.182742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Objectives: To examine the practices related paediatric adenotonsillectomy in our setting especially in relation to blood request and transfusion, routine investigations, post-operative analgesic practice and complications. Methods: We reviewed the record of paediatric patients who had adenotonsillectomy in our facility over a 5-year period to obtain relevant information to our study. Results: There were 33 males and 19 females with mean age of 3.27 ± 2.76 years. Sinus tachycardia was found in 11(21.2 %) of the subjects and T wave anomaly in 1(1.9%) of the subject. Thirty-five (67.3%) patient had adenotonsillectomy, 13(25.0 %) adenoidectomy only and 4(7.7%) tonsillectomy only. Majority of the patients (24, 46.2%) were classified as ASA physical status I. Pre-operative blood request rate was high (49, 94.3%) though the transfusion rate was 1.9 % (1 patient). Acetaminophen combined with other analgesics was used for post-operative analgesia for most of the patients. There was significant weight gain post-operatively among patient Conclusions: Cold steel adenotonsillectomy is safe and effective in our environment. We believe that there is no justification for routine pre-operative blood request as a preconditions for surgery. We also like to suggest that post-operative pain management be streamlined taking into consideration the available analgesics in our setting.
Collapse
Affiliation(s)
- Sanyaolu Alani Ameye
- Department of Surgery, Otorhinolaryngology Unit, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | - Adekunle Adeyemo
- Department of Surgery, Otorhinolaryngology Unit, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Anthony T Adenekan
- Department of Anaesthesia and Intensive Care, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Sylvia Ouche
- Department of Otorhinolaryngology Head and Neck Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| |
Collapse
|
8
|
Association of adenotonsillectomy with asthma outcomes in children: a longitudinal database analysis. PLoS Med 2014; 11:e1001753. [PMID: 25369282 PMCID: PMC4219664 DOI: 10.1371/journal.pmed.1001753] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 09/22/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Childhood asthma and obstructive sleep apnea (OSA), both disorders of airway inflammation, were associated in recent observational studies. Although childhood OSA is effectively treated by adenotonsillectomy (AT), it remains unclear whether AT also improves childhood asthma. We hypothesized that AT, the first line of therapy for childhood OSA, would be associated with improved asthma outcomes and would reduce the usage of asthma therapies in children. METHODS AND FINDINGS Using the 2003-2010 MarketScan database, we identified 13,506 children with asthma in the United States who underwent AT. Asthma outcomes during 1 y preceding AT were compared to those during 1 y following AT. In addition, 27,012 age-, sex-, and geographically matched children with asthma without AT were included to examine asthma outcomes among children without known adenotonsillar tissue morbidity. Primary outcomes included the occurrence of a diagnostic code for acute asthma exacerbation (AAE) or acute status asthmaticus (ASA). Secondary outcomes included temporal changes in asthma medication prescriptions, the frequency of asthma-related emergency room visits (ARERs), and asthma-related hospitalizations (ARHs). Comparing the year following AT to the year prior, AT was associated with significant reductions in AAE (30.2%; 95% CI: 25.6%-34.3%; p<0.0001), ASA (37.9%; 95% CI: 29.2%-45.6%; p<0.0001), ARERs (25.6%; 95% CI: 16.9%-33.3%; p<0.0001), and ARHs (35.8%; 95% CI: 19.6%-48.7%; p = 0.02). Moreover, AT was associated with significant reductions in most asthma prescription refills, including bronchodilators (16.7%; 95% CI: 16.1%-17.3%; p<0.001), inhaled corticosteroids (21.5%; 95% CI: 20.7%-22.3%; p<0.001), leukotriene receptor antagonists (13.4%; 95% CI: 12.9%-14.0%; p<0.001), and systemic corticosteroids (23.7%; 95% CI: 20.9%-26.5%; p<0.001). In contrast, there were no significant reductions in these outcomes in children with asthma who did not undergo AT over an overlapping follow-up period. Limitations of the MarketScan database include lack of information on race and obesity status. Also, the MarketScan database does not include information on children with public health insurance (i.e., Medicaid) or uninsured children. CONCLUSIONS In a very large sample of privately insured children, AT was associated with significant improvements in several asthma outcomes. Contingent on validation through prospectively designed clinical trials, this study supports the premise that detection and treatment of adenotonsillar tissue morbidity may serve as an important strategy for improving asthma control. Please see later in the article for the Editors' Summary.
Collapse
|
9
|
Goldfarb J, Gupta V, Sampson H, Chiodo A. Resource development in otolaryngology-head and neck surgery: an analysis on patient education resource development. J Otolaryngol Head Neck Surg 2014; 43:27. [PMID: 25022351 PMCID: PMC4108223 DOI: 10.1186/s40463-014-0027-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 06/30/2014] [Indexed: 12/04/2022] Open
Abstract
Background There is a need for educational tools in the consenting process of otolaryngology-head and neck procedures. A development strategy for the creation of educational tools in otolaryngology-head and neck surgery, particularly pamphlets on the peri-operative period in an adenotonsillectomy, is described. Methods A participatory design approach, which engages key stakeholders in the development of an educational tool, is used. Pamphlets were created through a review of traditional and grey literature and then reviewed by a community expert in the field. The pamphlets were then reviewed by an interdisciplinary team including educational experts, and finally by less vulnerable members of the target population. Questionnaires evaluating the pamphlets’ content, layout, style, and general qualitative features were included. Results The pamphlets yielded high ratings across all domains regardless of patient population. General feedback was provided by a non-vulnerable patient population and final pamphlets were drafted. Conclusions By using a participatory design model, the pamphlets are written at an appropriate educational level to incorporate a broad audience. Furthermore, this methodology can be used in future resource development of educational tools.
Collapse
Affiliation(s)
- Jeremy Goldfarb
- Undergraduate Medical Education, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Vishaal Gupta
- Undergraduate Medical Education, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Heather Sampson
- Department of Family and Community Medicine, University of Toronto, Office of Research, Toronto East General Hospital, 825 Coxwell Avenue, Toronto M4C 3E7, Ontario, Canada
| | - Albino Chiodo
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto East General Hospital, 825 Coxwell Avenue, Toronto M4C 3E7, Ontario, Canada
| |
Collapse
|
10
|
Subramanyam R, Chidambaran V, Ding L, Myer CM, Sadhasivam S. Anesthesia- and opioids-related malpractice claims following tonsillectomy in USA: LexisNexis claims database 1984-2012. Paediatr Anaesth 2014; 24:412-20. [PMID: 24417679 DOI: 10.1111/pan.12342] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although commonly performed, tonsillectomy is not necessarily a low-risk procedure for litigation. We have reviewed malpractice claims involving fatal and nonfatal injuries following tonsillectomy with an emphasis on anesthesia- and opioid-related claims and their characteristics. METHODS Tonsillectomy-related malpractice claims and jury verdict reports from the United States (US) between 1984 and 2012 found in the LexisNexis MEGA™ Jury Verdicts and Settlements database were reviewed by two independent reviewers. LexisNexis database collects nationwide surgical, anesthesia, and other malpractice claims. Data including years of case and verdicts, surgical, anesthetic and postoperative opioid-related complications, details of injury, death, cause of death, litigation result, and judgment awarded were analyzed. When there were discrepancies between the two independent reviewers, a third reviewer (SS) was involved for resolution. Inflation adjusted monetary awards were based on 2013 US dollars. RESULTS There were 242 tonsillectomy-related claim reports of which 98 were fatal claims (40.5%) and 144 nonfatal injury claims (59.5%). Verdict/settlement information was available in 72% of cases (n = 175). The median age group of patients was 8.5 years (range 9 months to 60 years). Primary causes for fatal claims were related to surgical factors (n = 39/98, 39.8%) followed by anesthesia-related (n = 36/98, 36.7%) and opioid-related factors (n = 16/98, 16.3%). Nonfatal injury claims were related to surgical (101/144, 70.1%), anesthesia (32/144, 22.2%)- and opioid-related factors (6/144, 4.2%). Sleep apnea was recorded in 17 fatal (17.4%) and 15 nonfatal claims (10.4%). Opioid-related claims had the largest median monetary awards for both fatal ($1 625 892) and nonfatal injury ($3 484 278) claims. CONCLUSIONS Tonsillectomy carries a high risk from a medical malpractice standpoint for the anesthesiologists and otolaryngologists. Although surgery-related claims were more common, opioids- and anesthetic-related claims were associated with larger median monetary verdicts, especially those associated with anoxic, nonfatal injuries. Caution is necessary when opioids are prescribed post-tonsillectomy, especially in patients with sleep apnea.
Collapse
Affiliation(s)
- Rajeev Subramanyam
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | | | | | | |
Collapse
|
11
|
Seshamani M, Vogtmann E, Gatwood J, Gibson TB, Scanlon D. Prevalence of Complications from Adult Tonsillectomy and Impact on Health Care Expenditures. Otolaryngol Head Neck Surg 2014; 150:574-81. [DOI: 10.1177/0194599813519972] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To provide information on the prevalence of common complications of adult tonsillectomy and associated health care utilization and expenditures. Study Design Retrospective analysis of a large insurance database. Setting Data from the MarketScan Commercial Claims and Encounters Database. Subjects and Methods Treated prevalence rates for post-tonsillectomy complications were calculated for 36,210 patients with employer-sponsored insurance who had an outpatient tonsillectomy between 2002 and 2007. The relationships with various patient characteristics were examined using multivariate logistic regression. Postoperative emergency department (ED) visits and hospitalizations and total per capita health care expenditures were analyzed. Results This analysis suggests that of adult patients who undergo a tonsillectomy, 20% will have a complication, 10% will visit an ED, and approximately 1.5% will be admitted to a hospital within 14 days of the tonsillectomy. Six percent were treated for postoperative hemorrhage, 2% for dehydration, and 11% for ENT pain within 14 days of surgery. Patients with comorbidities, prior peritonsillar abscess, or an increased number of antibiotic prescriptions in the past year were significantly more likely to develop complications. Three out of 4 patients with postoperative hemorrhage went to the ED (4.63% of all patients), and 50% had a procedural intervention (3.09% overall). The average cost associated with a tonsillectomy was $3832 if no complication. If there was a complication within 14 days, hemorrhage was the most expensive ($6388 vs $5753 for dehydration and $4708 for ENT pain). Conclusions Complications of adult outpatient tonsillectomies are common and may be associated with significant morbidity, health care utilization, and expenditures.
Collapse
Affiliation(s)
- Meena Seshamani
- Department of Head and Neck Surgery, The Permanente Medical Group, San Francisco, California, USA
| | | | | | | | - Dennis Scanlon
- The Pennsylvania State University, State College, Pennsylvania, USA
| |
Collapse
|
12
|
Goldman JL, Baugh RF, Davies L, Skinner ML, Stachler RJ, Brereton J, Eisenberg LD, Roberson DW, Brenner MJ. Mortality and major morbidity after tonsillectomy: etiologic factors and strategies for prevention. Laryngoscope 2013; 123:2544-53. [PMID: 23595509 DOI: 10.1002/lary.23926] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Revised: 10/03/2012] [Accepted: 11/08/2012] [Indexed: 12/14/2022]
Abstract
OBJECTIVE/HYPOTHESIS To report data on death or permanent disability after tonsillectomy. STUDY DESIGN Electronic mail survey. METHODS A 32-question survey was disseminated via the American Academy of Otolaryngology-Head and Neck Surgery electronic newsletter. Recipients were queried regarding adverse events after tonsillectomy, capturing demographic data, risk factors, and detailed descriptions. Events were classified using a hierarchical taxonomy. RESULTS A group of 552 respondents reported 51 instances of post-tonsillectomy mortality, and four instances of anoxic brain injury. These events occurred in 38 children (71%), 15 adults (25%), and two patients of unstated age (4%). The events were classified as related to medication (22%), pulmonary/cardiorespiratory factors (20%), hemorrhage (16%), perioperative events (7%), progression of underlying disease (5%), or unexplained (31%). Of unexplained events, all but one occurred outside the hospital. One or more comorbidities were identified in 58% of patients, most often neurologic impairment (24%), obesity (18%), or cardiopulmonary compromise (15%). A preoperative diagnosis of obstructive sleep apnea was not associated with increased risk of death or anoxic brain injury. Most events (55%) occurred within the first 2 postoperative days. Otolaryngologists who reported performing <200 tonsillectomies per year were more likely to report an event (P < .001). CONCLUSIONS This study, the largest collection of original reports of post-tonsillectomy mortality to date, found that events unrelated to bleeding accounted for a preponderance of deaths and anoxic brain injury. Further research is needed to establish best practices for patient admission, monitoring, and pain management. LEVEL OF EVIDENCE N/A.
Collapse
Affiliation(s)
- Julie L Goldman
- Division of Otolaryngology, Department of Surgery, University of Louisville, Louisville, Kentucky
| | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Khirani S, Leboulanger N, Ramirez A, Fauroux B. Life-threatening obstructive sleep apnea caused by adenoid hypertrophy in an infant with noonan syndrome. Case Rep Pediatr 2012; 2012:514514. [PMID: 23198236 PMCID: PMC3502807 DOI: 10.1155/2012/514514] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 10/03/2012] [Indexed: 11/30/2022] Open
Abstract
Adenoidectomy is a commonly performed surgery in children, even though its effectiveness is still under investigation. However, in children with risk factors such as age under 3 years old, associated comorbidities, or severe obstructive sleep apneas, a high postoperative respiratory morbidity is possible. We report the case of a 15-month-old boy with Noonan syndrome and a complex clinical history, who presented with a life-threatening obstructive sleep apnea due to hypertrophy of the adenoids which resolved completely after adenoidectomy.
Collapse
Affiliation(s)
- Sonia Khirani
- IP Santé, 94200 Ivry sur Seine, France
- Pediatric Pulmonary Department, AP-HP, Hôpital Armand Trousseau, 75012 Paris, France
| | - Nicolas Leboulanger
- Pediatric Head and Neck Surgery Department, AP-HP, Hôpital Armand Trousseau, 75012 Paris, France
- Université Pierre et Marie Curie-Paris 6, 75012 Paris, France
| | - Adriana Ramirez
- Pediatric Pulmonary Department, AP-HP, Hôpital Armand Trousseau, 75012 Paris, France
- ADEP Assistance, 92150 Suresnes, France
| | - Brigitte Fauroux
- Pediatric Pulmonary Department, AP-HP, Hôpital Armand Trousseau, 75012 Paris, France
- Université Pierre et Marie Curie-Paris 6 and INSERM U 955, 94000 Créteil, France
| |
Collapse
|
14
|
Abstract
Objectives: We performed a prospective observation study in an outpatient surgical and office setting to compare human post-tonsillectomy healing to human cutaneous wound healing and to established animal models of oral healing. Methods: Fourteen teenaged patients underwent planned tonsillectomy. Intraoral digital photographs were collected at the time of tonsillectomy, during the management of complications, and at postoperative office visits. Serial intraoral photographs of one patient were taken at 48-hour intervals from the time of surgery until postoperative day 17. Results: Intraoral photographs from the days after tonsillectomy revealed a pattern of inflammation and healing that closely paralleled that in human skin and in canine and porcine oral wound models. Conclusions: Edema and pain are greatest immediately after surgery, probably as a result of thermal effects and expression of inflammatory mediators that stimulate pharyngeal nociceptors. Pain gradually decreases over time, with an increase in analog pain measures on postoperative days 3 to 5 corresponding to the maximal wound inflammation documented in experimental models. Epithelial ingrowth beneath a fibrin clot begins shortly after wounding. Separation of the fibrin clot about 7 days after surgery exposes vascular stroma. Involution of the vascular stroma and completion of epithelial coverage correlate with decreased pain levels and a lessened risk of bleeding.
Collapse
|
15
|
Ergil J, Akkaya T, Gozaydin O, Gunsoy B, Alicura S, Aladag E, Gumus H, Akin I. Vasoconstrictive and analgesic efficacy of locally infiltrated levobupivacaine in tonsillectomy patients. Int J Pediatr Otorhinolaryngol 2012; 76:1429-33. [PMID: 22776810 DOI: 10.1016/j.ijporl.2012.06.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 06/11/2012] [Accepted: 06/15/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The use of preincisional plain levobupivacaine, lidocaine adrenaline and saline for perioperative blood loss and postoperative analgesia in pediatric tonsillectomy patients are compared. METHODS Ninety patients were randomly assigned into one of the 3 groups to receive preincisional peritonsillar infiltration of levobupivacaine 0.25% (group LB), lidocaine-adrenaline 1% with 1:200,000 (group LA) and saline (group S) under general anesthesia. Intraoperative blood loss, pre- and postoperative hemoglobin (hb) and haematocrit (htc) values, hemostasis time, operation duration, number of cautery used (20 W, 1s) and heart rates were recorded. Pain scores in PACU, at 6th, 12th and 24th hours postoperatively and the number of the patients requiring analgesic treatment for first 24h was also recorded. RESULTS There was a 30% reduction in perioperative blood loss in group LB and 63% reduction in group LA compared to group S (39 ± 6, 21 ± 4 and 55 ± 7 ml respectively) (p<0.001). Even though all three groups have significantly lower postoperative hb and htc values with respect to preoperative levels both local anesthetic groups had significantly higher postoperative hb and htc values than saline (p<0.001). Time required for hemostasis, the number of cautery used for haemostasis and operation duration were lower in groups LB and LA with respect to group S. Pain scores of the group LB revealed a significantly lower score throughout 24h. Only 14 patients in group LB demanded additional analgesic where as all patients in the other groups had. Adding adrenaline to the local anesthetic solution showed no side effects. Also we did not happened to see any complications related to local anesthetic injections. There was no postoperative major bleeding in groups. CONCLUSION Levobupivacaine has a vasoconstrictive effect in 0.25% concentrations that may be beneficial in tonsillectomy patients and has a consistent analgesic effect.
Collapse
Affiliation(s)
- Julide Ergil
- Ministry of Health Diskapi Yildirim Beyazit Training and Research Hospital, Anesthesiology Departement, Turkey.
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Setabutr D, Patel H, Choby G, Carr MM. Predictive factors for prolonged hospital stay in pediatric tonsillectomy patients. Eur Arch Otorhinolaryngol 2012; 270:1775-81. [DOI: 10.1007/s00405-012-2188-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Accepted: 09/07/2012] [Indexed: 11/30/2022]
|
17
|
Peripheral facial palsy after adenotonsillectomy in children. Int J Pediatr Otorhinolaryngol 2012; 76:1379-81. [PMID: 22682670 DOI: 10.1016/j.ijporl.2012.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 05/01/2012] [Indexed: 11/24/2022]
Abstract
Transient facial palsy is a rare complication after adenotonsillectomy. In this study, we report two cases who developed unilateral peripheral facial palsy immediately after adenotonsillectomy. The facial palsy in both cases completely recovered in 6 and 3h respectively without any treatment. We assumed the possible mechanism was deep infiltration of the local anesthetics into parapharyngeal space and then the direct action on the facial nerve. Therefore, we suggest three policies to avoid this complication: (1) inject the local anesthetics exactly into peritonsillar space, (2) avoid repeated injections or overdose, (3) slowly and gently inject the local anesthetics.
Collapse
|
18
|
Beebe DW, Rausch J, Byars KC, Lanphear B, Yolton K. Persistent snoring in preschool children: predictors and behavioral and developmental correlates. Pediatrics 2012; 130:382-9. [PMID: 22891224 PMCID: PMC3428758 DOI: 10.1542/peds.2012-0045] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To clarify whether persistent snoring in 2- to 3-year-olds is associated with behavioral and cognitive development, and to identify predictors of transient and persistent snoring. METHODS Two hundred forty-nine mother/child pairs participated in a prospective birth cohort study. Based upon parental report of loud snoring ≥ 2 times weekly at 2 and 3 years of age, children were designated as nonsnorers, transient snorers (snored at 2 or 3 years of age, but not both), or persistent snorers (snored at both ages). We compared groups by using validated measures of behavioral and cognitive functioning. Potential predictors of snoring included child race and gender, socioeconomic status (parent education and income), birth weight, prenatal tobacco exposure (maternal serum cotinine), childhood tobacco exposure (serum cotinine), history and duration of breast milk feeding, and body mass relative to norms. RESULTS In multivariable analyses, persistent snorers had significantly higher reported overall behavior problems, particularly hyperactivity, depression, and inattention. Nonsnorers had significantly stronger cognitive development than transient and persistent snorers in unadjusted analyses, but not after demographic adjustment. The strongest predictors of the presence and persistence of snoring were lower socioeconomic status and the absence or shorter duration of breast milk feeding. Secondary analyses suggested that race may modify the association of childhood tobacco smoke exposure and snoring. CONCLUSIONS Persistent, loud snoring was associated with higher rates of problem behaviors. These results support routine screening and tracking of snoring, especially in children from low socioeconomic backgrounds; referral for follow-up care of persistent snoring in young children; and encouragement and facilitation of infant breastfeeding.
Collapse
Affiliation(s)
- Dean W. Beebe
- Divisions of Behavioral Medicine and Clinical Psychology,,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Joseph Rausch
- Divisions of Behavioral Medicine and Clinical Psychology,,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Kelly C. Byars
- Divisions of Behavioral Medicine and Clinical Psychology,,Pulmonary Medicine, and,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Bruce Lanphear
- Faculty of Health Sciences, Simon Fraser University and Child and Family Research Institute, British Columbia Children’s Hospital, Vancouver, British Columbia, Canada; and
| | - Kimberly Yolton
- General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; ,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| |
Collapse
|
19
|
Current world literature. Curr Opin Otolaryngol Head Neck Surg 2012; 19:486-8. [PMID: 22555543 DOI: 10.1097/moo.0b013e32834e4a77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
20
|
Ekici F, Tekbas G, Onder H, Gumus H, Cetincakmak MG, Palanci Y, Bakir S, Bilici A. Course anomalies of extracranial internal carotid artery and their relationship with pharyngeal wall: an evaluation with multislice CT. Surg Radiol Anat 2012; 34:625-31. [DOI: 10.1007/s00276-012-0958-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 03/03/2012] [Indexed: 11/29/2022]
|