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Sociodemographic associations of geographic variation in paediatric tonsillectomy and adenoidectomy. Sci Rep 2021; 11:15896. [PMID: 34354175 PMCID: PMC8342528 DOI: 10.1038/s41598-021-95522-5] [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: 01/25/2021] [Accepted: 07/15/2021] [Indexed: 11/18/2022] Open
Abstract
Geographic variation of paediatric tonsillectomy, with or without adenoidectomy, (A/T) has been described since the 1930s until today but no studies have investigated the factors associated with this variation. This study described the geographical distribution of paediatric A/T across the state of Victoria, Australia, and investigated area-level factors associated with this variation. We used linked administrative datasets capturing all paediatric A/T performed between 2010 and 2015 in Victoria. Surgery data were collapsed by patient residence to the level of Local Government Area. Regression models were used to investigate the association between likelihood of surgery and area-level factors. We found a 10.2-fold difference in A/T rates across the state, with areas of higher rates more in regional than metropolitan areas. Area-level factors associated with geographic variation of A/T were percentage of children aged 5–9 years (IRR 1.07, 95%CI 1.01–1.14, P = 0.03) and low English language proficiency (IRR 0.95, 95% CI 0.90–0.99, P = 0.03). In a sub-population analysis of surgeries in the public sector, these factors were low maternal educational attainment (IRR 1.09, 95% CI 1.02–1.16, P < 0.001) and surgical waiting time (IRR 0.99635 95% CI 0.99273–0.99997, P = 0.048). Identifying areas of focus for improvement and factors associated with geographic variation will assist in improving equitable provision of paediatric A/T and decrease variability within regions.
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Deitmer T, Dietz A, Delank KW, Plontke SK, Welkoborsky HJ, Dazert S. [Outpatient Surgery in German ENT]. Laryngorhinootologie 2021. [PMID: 33822330 DOI: 10.1055/a-1418-9745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Currently there is an intense discussion ongoing to enhance and expand outpatient surgery in the ENT in Germany, which is the intention by several politicians. The goal is to achieve a frequency of outpatient surgery comparable to an international level.To achieve this goal, acceptance of outpatient interventions by both, surgeons and patients is required, particularly in regard of equal quality standards and patient safety requirements.In the following review the organization, outcome, quality management and strategies for different ENT outpatient surgery worldwide is analyzed. Basically, outpatient surgery is organized in different ways: office-based-procedures in local anesthesia, procedures in ambulatory surgery center settings as standalone facilities or in connection with and adjacent to a hospital with possible inpatient treatment. Contact and resident times of the patients in the outpatient surgery centers differ between some hours through 23 hours. A deliberated and careful selection of patients which are suitable for outpatient procedures is required and should address comorbidities, medications, social circumstances, health literacy of the patient and its relatives, and distance from home to the hospital. A careful and strict quality management is mandatory which comprises the entire process from patient selection through patient entry, surgery, discharge and postoperative care in a multidisciplinary setting.Zur besseren Lesbarkeit des Textes wird bei geschlechterbezogenen Bezeichnungen die männliche Form benutzt. Es sind jedoch in gleicher Rangfolge auch das jeweilige weibliche Geschlecht oder andere Geschlechtsausprägungen gemeint.
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Affiliation(s)
- Thomas Deitmer
- Deutsche Gesellschaft für HNO-Heilkunde, Kopf- und Halschirurgie, Bonn, Germany
| | - Andreas Dietz
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Plastische Operationen, Universität Leipzig, Leipzig, Germany
| | - K-Wolfgang Delank
- HNO-Klinik, Klinikum der Stadt Ludwigshafen gGmbH, Ludwigshafen, Germany
| | - Stefan K Plontke
- Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsklinikum Halle (Saale), Halle (Saale), Germany
| | - H-J Welkoborsky
- Klinik für HNO-Heilkunde, regionale plastische Chirurgie, Kopf- und Halschirurgie, Klinikum Region Hannover GmbH, Hannover, Germany
| | - Stefan Dazert
- Klinik für HNO-Heilkunde, Kopf- und Hals-Chirurgie, St. Elisabeth-Hospital, Klinikum der Ruhr-Universität Bochum, Germany
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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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Kim KS, Min HJ. Correlations Between the Adenotonsillar Microbiome and Clinical Characteristics of Pediatric Patients With Snoring. Clin Exp Otorhinolaryngol 2020; 14:295-302. [PMID: 33181009 PMCID: PMC8373842 DOI: 10.21053/ceo.2020.01634] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 11/10/2020] [Indexed: 12/12/2022] Open
Abstract
Objectives Few studies have reported combined analyses of the microbiome of the adenoids and tonsils in pediatric patients with snoring, and correlations of the adenotonsillar microbiome with clinical characteristics have not been evaluated to date. The aim of this study was to characterize the adenotonsillar microbiome and to determine its correlations with the subjective symptoms of pediatric patients with snoring and with levels of regional mucosal immune molecules. Methods Twenty-four children who underwent tonsillectomy with adenoidectomy owing to snoring were enrolled in this cross-sectional study conducted between August 2017 and December 2018. The microbiome of the adenoids and tonsils was characterized, and its alpha- and beta-diversity was determined. Clinical characteristics, including subjective discomfort during sleep (assessed using the obstructive sleep apnea-18 questionnaire), the presence of allergic rhinitis, concentrations of heat shock protein (Hsp)27, Hsp70, and interleukin-8 (IL-8) in lavage fluids, and white blood cell (WBC) counts, were measured. Results At the phylum level, the microbiome was not significantly different between the adenoids and tonsils; the alpha and beta indices were likewise not significantly different between these two regions. The alpha-diversity of the entire adenotonsillar microbiome was associated with sex, emotional stress, and IL-8 levels in the tonsil lavage fluids. Beta-diversity was associated with Hsp27 levels in the tonsil lavage fluids and WBC counts. Multiple allergen simultaneous test results were not significant, although total serum immunoglobulin E levels were significantly associated with the beta-diversity of the adenotonsillar microbiome. Conclusion The data reported herein suggest, for the first time, that the adenotonsillar microbiome interacts with the regional mucosal immune system. The observed association of the microbiome with subjective discomfort is a novel finding that warrants further investigation.
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Affiliation(s)
- Kyung Soo Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyun Jin Min
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
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Grønlund C, Howitz MF, Djurhuus BD. No impact on the incidence rate of adenoidectomy 1998-2014 on a national level in Denmark by the use of nasal steroid and the introduction of pneumococcal vaccines. Clin Otolaryngol 2019; 45:111-118. [PMID: 31724810 DOI: 10.1111/coa.13475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/31/2019] [Accepted: 11/09/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe trends in incidence rates of adenoidectomy in children in Denmark from 1998-2014 and to look for possible explanatory factors such as intranasal steroids and pneumococcal vaccination. DESIGN A nationwide, population-based, retrospective, interrupted time-series analysis, using data from Danish registries. SETTING Hospitals and private Ear, Nose and Throat clinics. PARTICIPANTS Children who underwent adenoidectomy from 1998 to 2014 in Denmark. MAIN OUTCOME MEASURE Adenoidectomy. METHODS The National Patient Register and the National Health insurance Service Register were used to identify all adenoidectomies performed in children. The National Prescription Register supplied data on intranasal steroids. RESULTS A total of 174,557 adenoidectomies were identified, distributed among 153 022 children. The annual incidence rate was stable at around 11 per 1000 person-years from 1998 to 2004. A decrease was seen from 2004 reaching 7.9 in 2009, followed by an increase to 9.1 in 2014. The highest age-specific incidence rates were seen at 2-3 years of age. An estimated 14% of children born in 2014 will have had adenoidectomy performed before turning 16 years old. The proportion of adenoidectomies performed in private clinics compared with hospitals was 90%. CONCLUSION From 1998 to 2004 the incidence rate of adenoidectomy in children in Denmark was among the highest in the world with around 11 per 1000 person-years. A decrease to 7.9 was seen from 2004 to 2009. We found no inverse correlation on a national level between the incidence rates of adenoidectomy and intranasal steroid, nor the introduction of the pneumococcal vaccine. The amount of intranasal steroids used in children in Denmark was negligible compared with adenoidectomy.
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Affiliation(s)
- Casper Grønlund
- Department of Otorhinolaryngology & Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - Michael Frantz Howitz
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, North Zealand Hospital, Hillerød, Denmark
| | - Bjarki Ditlev Djurhuus
- Department of Otorhinolaryngology & Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
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Tran AH, Horne RS, Liew D, Rimmer J, Nixon GM. An epidemiological study of paediatric adenotonsillectomy in Victoria, Australia, 2010‐2015: Changing indications and lack of effect of hospital volume on inter‐hospital transfers. Clin Otolaryngol 2019; 44:1037-1044. [DOI: 10.1111/coa.13436] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/11/2019] [Accepted: 09/13/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Aimy H.L. Tran
- The Ritchie Centre Hudson Institute of Medical Research and Department of Paediatrics Monash University Melbourne Victoria Australia
| | - Rosemary S.C. Horne
- The Ritchie Centre Hudson Institute of Medical Research and Department of Paediatrics Monash University Melbourne Victoria Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
| | - Joanne Rimmer
- Department of Otolaryngology, Head and Neck Surgery Monash Health Melbourne Victoria Australia
- Department of Surgery Monash University Melbourne Victoria Australia
| | - Gillian M. Nixon
- The Ritchie Centre Hudson Institute of Medical Research and Department of Paediatrics Monash University Melbourne Victoria Australia
- Melbourne Children’s Sleep Centre Monash Children’s Hospital Melbourne Victoria Australia
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Johnston J, Hoggard M, Biswas K, Astudillo-García C, Radcliff FJ, Mahadevan M, Douglas RG. Paired analysis of the microbiota between surface tissue swabs and biopsies from pediatric patients undergoing adenotonsillectomy. Int J Pediatr Otorhinolaryngol 2018; 113:51-57. [PMID: 30174010 DOI: 10.1016/j.ijporl.2018.07.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 07/17/2018] [Accepted: 07/17/2018] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Culture-independent methods, based on bacterial 16 S rRNA gene sequencing, have been used previously to investigate the adenotonsillar microbiota. However, these studies have focused on a single sampling site (usually a surface swab). We aimed to investigate potential differences in adenotonsillar microbiota according to sampling location, both on and within the adenoids and palatine tonsils. METHODS Pediatric patients (n = 28, mean age five years) undergoing adenotonsillectomy were recruited for this study. At the time of surgery, a mucosal adenoid surface swab and an adenoid tissue biopsy was collected. Immediately following surgery, the crypts of the right and left tonsils were swabbed, and a surface and core tissue sample from the right tonsil were also collected. Bacterial 16 S rRNA gene-targeted amplicon sequencing was used to determine the bacterial composition of the collected samples. RESULTS There was no significant difference in diversity or composition of the adenoid microbiota based on sampling site. However, the Shannon-Wiener and Inverse-Simpson diversity indices differed significantly (p < 0.05) between the microbial communities of the three different tonsil sampling sites. There was a higher average relative abundance of members from the genera Streptococcus, Actinobacillus, and Neisseria in the tonsil crypts when compared with surface and core tonsil tissue samples. CONCLUSION Our results indicate that there is variation in bacterial diversity and composition based on sampling sites in the tonsils but not the adenoids. The difference in microbiota between the surface and the tissue may have implications for our understanding of the pathogenesis of recurrent tonsillitis and have treatment implications.
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Affiliation(s)
- James Johnston
- Department of Surgery, The University of Auckland, Auckland, New Zealand.
| | - Michael Hoggard
- School of Biological Sciences, The University of Auckland, Auckland, New Zealand
| | - Kristi Biswas
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | | | - Fiona J Radcliff
- Department of Molecular Medicine and Pathology, The University of Auckland, Auckland, New Zealand
| | - Murali Mahadevan
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Richard G Douglas
- Department of Surgery, The University of Auckland, Auckland, New Zealand
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Chen JW, Liao PW, Hsieh CJ, Chen CC, Chiou SJ. Factors associated with changing indications for adenotonsillectomy: A population-based longitudinal study. PLoS One 2018; 13:e0193317. [PMID: 29843158 PMCID: PMC5973846 DOI: 10.1371/journal.pone.0193317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 02/08/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Adenotonsillectomy (AT) is one of the most common surgical procedures performed in children and adults. We aim to assess the factors associated with changes in the incidence of and indications for AT using population-level data. STUDY DESIGN This retrospective cohort study investigated patients who underwent AT between 1997 and 2010 by using data from the Taiwan National Health Insurance Research Database. We examined surgical rates and indications by the calendar year as well as age, sex, hospital level, and insured residence areas for the correlating factors. RESULTS The average annual incidence rate of AT was 14.7 per 100,000 individuals during 1997-2010. Pediatric (<18 years) patients represented 48.2% of the total AT population. More than 99% of the patients underwent the AT procedures as an inpatient intervention. Longitudinal data demonstrated an increasing trend in the pediatric AT rates from 1997 (4.3/100,000) to 2010 (5.7/100,000) (p = 0.029). In the adult subgroup, a decreasing prevalence of infectious indications (p = 0.014) coincided with an increasing neoplastic indications (p = 0.001). In the pediatric subgroup, the prevalence of obstructive indications increased (p = 0.002). The logistic regression analyses indicated that the significant factors associated with the changing surgical indications for AT were the age in the adult subgroup and hospital level in the pediatric subgroup. CONCLUSIONS This study revealed a low AT rate in Taiwan than that in other countries. Pediatric AT incidence increased during 1997-2010. Although a rising prevalence of obstructive and neoplastic indications was noted, infection remained the most common indications for AT. Age in the adult subgroup and hospital level in the pediatric subgroup were factors associated with the changing indications for AT.
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Affiliation(s)
- Jeng-Wen Chen
- Department of Otolaryngology-Head and Neck Surgery, Catholic Cardinal Tien Hospital and School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
- Department of Otolaryngology-Head and Neck Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Wu Liao
- Department of Otolaryngology, Catholic Yonghe Cardinal Tien Hospital, New Taipei City, Taiwan
| | - Chi-Jeng Hsieh
- Department of Health Care Administration, Oriental Institute of Technology, New Taipei City, Taiwan
| | - Chu-Chieh Chen
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Shang-Jyh Chiou
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- * E-mail:
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