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Alm F, Odhagen E, Sunnergren O, Nerfeldt P. Postoperative Analgesic Regimens and Their Satisfaction Rates-Data from the Swedish Quality Register for Tonsil Surgery. Laryngoscope 2024. [PMID: 39140262 DOI: 10.1002/lary.31691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/29/2024] [Accepted: 07/26/2024] [Indexed: 08/15/2024]
Abstract
OBJECTIVE To describe postoperative analgesic regimens and patient-reported pain-related outcomes after tonsil surgery. METHODS Cohort study including perioperative data (n = 9274) and patient-reported outcome measures (n = 5080) registered in the Swedish Quality Register for Tonsil Surgery during 2023. RESULTS After tonsil surgery, 92.7% received at least paracetamol and a NSAID/COX inhibitor, while 6.8% received no NSAID/COX inhibitor. Opioids were prescribed after tonsillectomy to 62.9% of adults and less often to adolescents and children (13-17-year-olds: 48.2%, 6-12-year-olds: 8.8%, 0-5-year-olds: 4.0%). Clonidine was frequently prescribed to 0-5-year-olds after tonsillectomy (54.4%). Overall, 11.7% reported dissatisfaction with the pain treatment, with the highest dissatisfaction rate after tonsillectomy in adolescents (20.6%) and adults (20.0%), and the lowest after tonsillotomy in children (4.9-6.8%). The most common complaint among dissatisfied patients was analgesics not being sufficiently helpful. Adult patients who received addition of opioids were less dissatisfied with the pain treatment (15.9% vs. 25.9%, p < 0.001), but also reported more side effects (5.7% vs. 2.7%, p = 0.039), compared with patients who received only paracetamol and NSAID/COX inhibitors. CONCLUSION Tonsil surgery patients in Sweden receive various analgesic regimens. Although most are satisfied with pain treatment, there is room for improvement, particularly among adolescents and adults undergoing tonsillectomy. Paracetamol and a NSAID/COX inhibitor seem advisable as basic treatment. However, many patients need more effective treatment. The addition of opioids in adults results in greater satisfaction with pain treatment, but safety issues with opioid prescriptions must be taken into consideration. LEVELS OF EVIDENCE Level 4 Laryngoscope, 2024.
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Affiliation(s)
- Fredrik Alm
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Erik Odhagen
- Department of Otorhinolaryngology, Södra Älvsborgs Hospital, Borås, Sweden
- Department of Otorhinolaryngology -Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ola Sunnergren
- Department of Otorhinolaryngology -Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Oral Health, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Department of Otorhinolaryngology, Region Jönköping County, Jönköping, Sweden
- Department of Otorhinolaryngology-Head and Neck Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Pia Nerfeldt
- Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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Wennberg S, Amundsen MF, Bugten V. A validation study of the 30-day questionnaire in the national Norwegian Tonsil Surgery Register: can we trust the data reported by the patients? Eur Arch Otorhinolaryngol 2024; 281:977-984. [PMID: 37910209 PMCID: PMC10796416 DOI: 10.1007/s00405-023-08306-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/17/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE The aim of this study was to validate the Patient Reported Outcome Measure (PROM) in the Norwegian Tonsil Surgery Register (NTSR) and to examine whether any improvements to the questionnaire could be useful. METHODS This is a prospective, descriptive study. NTSR collects data from patients who undergo tonsil surgery and the intention of the register is to improve the quality of treatment and to contribute to research. The patients answers questions about admission due to postoperative haemorrhage, infection and pain 30 days after surgery. 305 patients were contacted on phone 1-2 weeks after answering the questionnaires electronically (ePROM) and asked the same questions. 180 of 305 patients we contacted had some kind of complications after surgery. They were asked additional questions to search for possible points for improvement of the questionnaire. RESULTS When comparing the results on the ePROM with the answers on phone, we found that 12 out of 14 variables achieve almost perfect agreement (AC1 ≥ 0.81). Two variables are categorized to be substantial agreement (AC1 = 0.61-0.80). The additional questions showed us that the questionnaire can be improved with more detailed information regarding the severity of the postoperative haemorrhage and the need of better treatment against postoperative pain. CONCLUSION This study shows that the information from the 30-day ePROM has high reliability. The questions were understood as they were intended, and the answers reflect what the patients had of complications. Some changes can be done to improve the questionnaire and to open up for more research around the tonsillectomy procedure.
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Affiliation(s)
- Siri Wennberg
- Department of Medical Quality Registries, St. Olav's University Hospital, Torgarden, P. O. Box 3250, 7006, Trondheim, Norway
| | - Marit Furre Amundsen
- Department of Medical Quality Registries, St. Olav's University Hospital, Torgarden, P. O. Box 3250, 7006, Trondheim, Norway
- Department of Otorhinolaryngology, Head and Neck Surgery, St. Olav's University Hospital, P. O. Box 3250, 7006, Trondheim, Norway
| | - Vegard Bugten
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491, Trondheim, Norway.
- Department of Medical Quality Registries, St. Olav's University Hospital, Torgarden, P. O. Box 3250, 7006, Trondheim, Norway.
- Department of Otorhinolaryngology, Head and Neck Surgery, St. Olav's University Hospital, P. O. Box 3250, 7006, Trondheim, Norway.
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Berglund M, Olaison S, Westman E, Eriksson PO, Steger L, Bonnard Å. Validation of the Swedish Quality Register for Ear Surgery - SwedEar. BMC Med Inform Decis Mak 2023; 23:240. [PMID: 37884909 PMCID: PMC10604449 DOI: 10.1186/s12911-023-02340-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 10/15/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND The Swedish Quality Register for Ear Surgery (SwedEar) is a national register monitoring surgical procedures and outcomes of ear surgery to facilitate quality improvement. The value of the register is dependent on the quality of its data. SwedEar has never been validated regarding data quality or missing entries. Therefor, the purpose of this study was to assess coverage, completeness and response rate in the register and validate the physicians' reported data accuracy. METHODS In this validation study, the completeness, response rate and missing registrations were analysed. Data in SwedEar were compared with the yearly collected statistics of otosurgical procedures in The Swedish Otosurgical Society and the comparison of rates between groups was calculated with Fisher's exact test. Validation of registered data accuracy was performed on every 20th registered case during a five-year period. Data were reabstracted from medical records and compared with the original registration. Interrater agreement, reliability measures, Cohen's kappa, Gwet's AC1 and positive predictive value were calculated. RESULTS SwedEar has a coverage of 100%. The completeness of registered cases was 84% and the response rate was 74%. The validation of data accuracy assessed 13 530 variables, including audiograms. Less than 3% of incorrect or missing variables were identified. For most of the pre- and postoperative variables the Kappa and Gwet´s AC1 results show an almost perfect agreement (> 0.80). For audiogram data the ICC shows an excellent reliability (> 0.9) for all but one value. CONCLUSION This validation shows that SwedEar has excellent coverage, high completeness, and that the data in the register have almost perfect reliability. The data are suitable for both clinical and research purposes. Further efforts to improve completeness are warranted.
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Affiliation(s)
- Malin Berglund
- Department of Otorhinolaryngology, NU Hospital Group, Trollhättan, Sweden
- Department of Biomaterials, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sara Olaison
- Department of Otorhinolaryngology, Örebro University Hospital, Örebro, Sweden
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Eva Westman
- Department of Clinical Sciences, Otorhinolaryngology, Umeå University, Site Sundsvall, Umeå, Sweden
| | - P O Eriksson
- Medical Unit of Ear, Nose and Throat, Hearing and Balance, Karolinska University Hospital, Stockholm, Sweden
- Department of Surgical Sciences, Otorhinolaryngology, Uppsala University Hospital, Uppsala, Sweden
| | - Lena Steger
- Department of Otorhinolaryngology, Gävle Hospital, Gävle, Sweden
| | - Åsa Bonnard
- Medical Unit of Ear, Nose and Throat, Hearing and Balance, Karolinska University Hospital, Stockholm, Sweden.
- Division of CLINTEC, Department of Otorhinolaryngology, Karolinska Institutet, Stockholm, Sweden.
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Sjölander I, Borgström A, Froissart Nerfeldt P, Fehrm J, Friberg D. Correlations between objective and subjective outcomes after adenotonsillar surgery in children with OSA. Laryngoscope Investig Otolaryngol 2022; 7:2161-2170. [PMID: 36544930 PMCID: PMC9764786 DOI: 10.1002/lio2.967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives To investigate whether the OSA-18 questionnaire and a postoperative patient-reported outcome measure (PROM) question correlated with polysomnography (PSG) data. Methods A prospective study of otherwise healthy young children with moderate to severe obstructive sleep apnea (OSA) to investigate if the obstructive apnea-hypopnea index (OAHI) before and 6-12 months after adenotonsil surgery correlated with the OSA-18 total symptom score (TSS) and the sleep disturbance subscale (SDS), as well as a PROM question on symptom improvement with responses on a 4-grade Likert scale. Results Of 201 children, 173 (86%) had complete data of OAHI and OSA-18 pre- and postoperatively. The mean age was 3.2 years (SD 1.0) and the mean OAHI was 15.9 (11.3). Significant correlations between changes in the OAHI and OSA-18 were found, both TSS (r = 0.29, p < .001) and SDS (r = 0.53, p < .001). A total of 136 (68%) patients responded to the PROM question, the majority of whose symptoms had disappeared (n = 102) or almost disappeared (n = 30). Four patients had unchanged symptoms, and none had worsening symptoms. A correlation was found between the PROM question and a change in the OAHI (r = 0.36, p < .001), as well as a change in the OSA-18 TSS (r = 0.24, p = .006) and the SDS (r = 0.34, p < .001). The specificity of the PROM question for prediction of a postoperative OAHI < 2 was 82%, and the sensitivity was 38%. Conclusion Changes in the OAHI significantly correlated with changes in the OSA-18, especially with the sleep disturbance scale, which could be an alternative for evaluation at follow-ups. Level of Evidence 3.
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Affiliation(s)
| | - Anna Borgström
- Department of Clinical Science, Intervention, and TechnologyCLINTEC, Karolinska InstitutetStockholmSweden
| | - Pia Froissart Nerfeldt
- Department of Clinical Science, Intervention, and TechnologyCLINTEC, Karolinska InstitutetStockholmSweden
| | - Johan Fehrm
- Department of Clinical Science, Intervention, and TechnologyCLINTEC, Karolinska InstitutetStockholmSweden
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Bugten V, Wennberg S, Amundsen MF, Blindheimsvik MAB. Reducing post-tonsillectomy haemorrhage: a multicentre quality improvement programme incorporating video-based cold technique instruction. BMJ Open Qual 2022; 11:bmjoq-2022-001887. [PMID: 36410782 PMCID: PMC9680151 DOI: 10.1136/bmjoq-2022-001887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 10/28/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Data from the Norwegian Tonsil Surgery Register (NTSR) showed large differences between the hospitals in Norway in the readmission rate due to post-tonsillectomy haemorrhage (rrPTH; range, 0%-25%; national average, 8%). Because of these large variations in the rrPTH, we conducted a quality improvement project involving hospitals with good and bad readmission rates. METHODS Seven hospitals with readmission rates greater than 10% and four with rates lower than 5% participated in this project. We recorded videos of ear, nose and throat surgeons from the hospitals with low readmission rates when they performed extracapsular tonsillectomy, and these videos of cold dissection tonsillectomy were used as teaching material for examples of good surgical skills for the other hospitals. After a 2-day workshop, all participants from the hospitals went back to their institutions and prepared local plans to improve their results. We used the Plan-Do-Study-Act model. The primary outcome variable was the patient-reported rrPTH in the NTSR. As secondary goal, we aimed to identify aspects of the tonsillectomy procedure that could help achieve a lower rrPTH. RESULTS The participating hospitals reduced their rrPTH from 18% at baseline (2017/2018) to 7% in 2020. Six of seven hospitals changed their dissection technique significantly to more use of cold dissection. CONCLUSION By learning cold dissection tonsillectomy from surgeons with low rrPTH, it seems possible to decrease the rates of bleeding complications after tonsillectomy. A combination of videos as a teaching tool, new treatment plans, and focus on quality and improvement may effectively improve surgical results. The videos can show details that are difficult to convey in the literature. Quality registers can be used to identify areas requiring improvement and evaluate the effects of changes in practice.
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Affiliation(s)
- Vegard Bugten
- Department of Otolaryngology, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway,Department of Medical Quality Registries, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
| | - Siri Wennberg
- Department of Medical Quality Registries, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
| | - Marit Furre Amundsen
- Department of Otolaryngology, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway,Department of Medical Quality Registries, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
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Stalfors J, Ovesen T, Bertelsen JB, Bugten V, Wennberg S, Sunnergren O. Comparison of clinical practice of tonsil surgery from quality register data from Sweden and Norway and one clinic in Denmark. BMJ Open 2022; 12:e056551. [PMID: 35477880 PMCID: PMC9047789 DOI: 10.1136/bmjopen-2021-056551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 03/16/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To compare the application of indications, demographics, surgical and haemostatic techniques in tonsil surgery in three countries. DESIGN Non-randomised, prospective, observational cohort. SETTING All patients registered in the National Tonsil Surgery Quality Registers in Sweden, Norway and West Jutland, Denmark. PARTICIPANTS Data were retrieved from 2017 to 2019; registered surgeries: Sweden: 20 833; Norway: 10 294 and West Jutland, Denmark: 505. RESULTS Tonsil surgery for obstruction was twice as common in Sweden (62.2%) compared with Norway (31%) and Denmark (27.7%). Recurrent tonsillitis was registered twice as frequently in Norway (35.7%) and Denmark (39%) compared with Sweden (16.7%). Chronic tonsillitis was registered more frequently in Norway (29.8%) than in Sweden (13.8%) and Denmark (12.7%). Day surgery (>76%) was comparable. The higher frequency of obstruction in Sweden affected age and gender distributions: Sweden (7 years, 50.4% boys), Norway (17 y, 42.1%) and Denmark (19 y, 38.4%). For obstructive disorders, tonsillotomy with adenoidectomy was used in a majority of Swedish children (72%), whereas tonsillectomy with or without adenoidectomy dominated in Norway (53.5%) and Denmark (57.9%). Cold steel was the technique of choice for tonsillectomy in all three countries. For tonsillotomy, hot dissection techniques dominated in all countries. Disparities were observed with regard to haemostatic techniques. Bipolar diathermy was commonly used in all countries. Monopolar diathermy was practically only used in Sweden. Infiltration with epinephrine in the tonsillar bed was registered in Sweden and Norway but not at all in Denmark. Combined cold surgical and cold haemostatic techniques were more commonly used in Sweden (22.7%) than in Norway (10.4%) and Denmark (6.2%). CONCLUSIONS This study demonstrates disparities among the Nordic countries in tonsil surgery in terms of indications plus surgical and haemostatic techniques. Increased coverage and further monitoring of outcomes is needed to identify best practices and ideal guidelines for improved care.
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Affiliation(s)
- Joacim Stalfors
- Department of Otolaryngology, Sahlgrenska Academy, Goteborg, Sweden
| | - Therese Ovesen
- Institute of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
| | | | - Vegard Bugten
- Department of Otorhinolaryngology - Head and Neck Surgery, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Siri Wennberg
- Department of Medical Quality Registries, St Olavs Hospital Trondheim University Hospital, Trondheim, Trøndelag, Norway
| | - Ola Sunnergren
- Department of Clinical and Experimental Medicine, Linköpings universitet Hälsouniversitetet, Linkoping, Sweden
- Department of Otorhinolaryngology, Region Jönköping County, Jonkoping, Sweden
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