1
|
Bhat A, Singh A, Durr ML, Chang JL. Patient Reported Outcome Measures used in Surgical Evaluation of Obstructive Sleep Apnea: A Systematic Review. Laryngoscope 2024. [PMID: 38982930 DOI: 10.1002/lary.31603] [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: 03/13/2024] [Revised: 05/15/2024] [Accepted: 06/12/2024] [Indexed: 07/11/2024]
Abstract
OBJECTIVE To identify patient-reported outcome measures (PROMs) used to measure adult obstructive sleep apnea (OSA)-related quality of life in sleep surgery and analyze key psychometric properties in the original design and development of each PROM. DATA SOURCES PubMed, Web of Science, Embase, PsychINFO, and CINAHL. REVIEW METHODS A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Disease-specific instruments assessing sleep-related quality of life that were used in sleep surgery studies and validated in patients with sleep disorders were included. The Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) criteria were used to evaluate methodological quality. RESULTS A total of 2494 abstracts were retrieved, and 216 underwent full-text review. Seven PROMs assessing sleep-related quality of life were identified. Only one (14%) PROM (SAQLI) was developed using both patient and physician input, and none were rated as "adequate" for content validity. Two PROMs utilized patients with sleep-disordered breathing during content development and none specifically queried patients considering surgery. Six (86%) PROMs demonstrated "very good" analysis of internal consistency per COSMIN criteria, and six (86%) included data on test-retest reliability. CONCLUSION Several PROMs are utilized in sleep-related quality-of-life assessments for patients treated with OSA surgery. The measurement properties of these PROMs are of variable quality, and notably, no PROMs meet adequate quality measurements for content validity. New and updated PROMs for OSA-related quality of life should consider input from sleep surgery patients and providers. Laryngoscope, 2024.
Collapse
Affiliation(s)
- Amrita Bhat
- Department of Otolaryngology Head and Neck Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Amritpal Singh
- Department of Otolaryngology Head and Neck Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Megan L Durr
- Department of Otolaryngology Head and Neck Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Jolie L Chang
- Department of Otolaryngology Head and Neck Surgery, University of California San Francisco, San Francisco, California, U.S.A
- Surgery Service, Department of Veterans Affairs Medical Center, San Francisco, California, U.S.A
| |
Collapse
|
2
|
Houborg HI, Klug TE. Evaluation of Guidelines For Tonsillectomy in Adults With Recurrent Acute Tonsillitis. Ann Otol Rhinol Laryngol 2023; 132:1573-1583. [PMID: 37183925 DOI: 10.1177/00034894231173481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVES The criteria for selecting patients with recurrent acute tonsillitis (RT) for tonsillectomy remain unsettled and different guidelines are used internationally. We aimed to evaluate currently used guidelines for tonsillectomy in adults with RT and identify the best predictive parameters for improved throat-related quality of life (TR-QOL) after surgery. METHODS About 66 RT patients undergoing tonsillectomy was prospectively included and categorized into 3 groups based on which guideline(s) they met: Group 1: patients not meeting any of the Danish/Paradise/Scottish Intercollegiate Guideline Network (SIGN) guidelines. Group 2: patients meeting the Danish guidelines. Group 3: patients meeting the Paradise and/or the SIGN guidelines. TR-QOL was assessed using the Tonsillectomy Outcome Inventory 14 (TOI-14) before and 6 months after tonsillectomy as well as the Glasgow Benefit Inventory (GBI). Predictive parameters for improved TR-QOL were investigated using multiple linear regression. RESULTS About 61 (92%) patients completed the questionnaires. Patients in all groups had significant TR-QOL improvements (Group 1 (n = 20): ΔTOI-14 31.1; GBI 29.4; Group 2 (n = 31): ΔTOI-14 32.0; GBI 36.4; Group 3 (n = 10): ΔTOI-14 45.6; GBI 39.7) and satisfaction rates were high (94%-100%). Preoperative TOI-14 score was the best predictor for improved TR-QOL (P < .001, R2 = .80), followed by the number of tonsillitis episodes with physician verification within the previous 12 months (P = .002, R2 = .25). CONCLUSIONS Patients in all groups experienced massive TR-QOL improvements suggesting that currently used guidelines may be too restrictive. Preoperative TOI-14 score was the best parameter for predicting TR-QOL improvement, and this tool may be useful in the selection of adults with RT for tonsillectomy.
Collapse
Affiliation(s)
- Hannah Inez Houborg
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Tejs Ehlers Klug
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
3
|
Plath M, Sand M, Behnen K, Plath K, Baumann I. Does a tonsillectomy indicated according to the German S2k guideline affect short-term quality of life in adults? Eur Arch Otorhinolaryngol 2023; 280:1963-1971. [PMID: 36441247 DOI: 10.1007/s00405-022-07758-0] [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: 10/16/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Tonsillectomy (TE) for recurrent tonsillitis (RT) is one of the most common surgical interventions. Since 2015, the indication criteria for TE have become much stricter (German S2k guideline). Patient-reported outcome measures (PROMs) of short-term quality of life (QoL) after TE have not yet been investigated. PURPOSE To clarify if stringent indication for TE will better identify patients worthy of surgery and patients' QoL. METHODS We prospectively studied the Tonsillectomy Outcome Inventory 14 (TOI-14) responses of 38 RT-patients recruited according to the S2k guideline in 2020 and compared their TOI-14 scores with those of a historical RT cohort from 2006 to 2008 and with a healthy middle-European cohort. New RT patients were assessed before, 2, 4, and 14 days and 6 months after TE. TOI-14 was measured as total and as disease-specific score. RESULTS From pre- to 6-month postoperative, patients' QoL was significantly different, measured by TOI-14 (49.92 vs. 6.35; p < 0.001) and disease-specific score (60.35 vs. 9.9; p < 0.001). Preoperative disease-specific score was not different from that of the 2nd and 4th postoperative days but from the 14th postoperative day (60.35 vs. 29.26; p < 0.001). The historical cohort had significantly less RT complaints than the new cohort beforehand, but more dissatisfaction in QoL after TE. New TE patients had worse QoL pre- (49.92 vs. 11.78; p < 0.001) but more QoL postoperatively (6.34 vs. 11.78; p = 0.004) than healthy individuals. CONCLUSIONS Our results show that the tightening of the indication criteria for TE was justified and that TE patients significantly benefit from this surgery from day 14.
Collapse
Affiliation(s)
- Michaela Plath
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Ruprecht-Karls-University, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Matthias Sand
- GESIS-Leibniz-Institute for the Social Sciences, Mannheim, Germany
| | - Kjell Behnen
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Ruprecht-Karls-University, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Karim Plath
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Ruprecht-Karls-University, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Ingo Baumann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Ruprecht-Karls-University, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| |
Collapse
|
4
|
Houborg HI, Klug TE. Quality of life after tonsillectomy in adult patients with recurrent acute tonsillitis: a systematic review. Eur Arch Otorhinolaryngol 2022; 279:2753-2764. [DOI: 10.1007/s00405-022-07260-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/04/2022] [Indexed: 11/29/2022]
|
5
|
Seethaler A, Stenner M, McNally A, Rudack C, Roth J, Vogl T, Spiekermann C. IL-8 and IFN-γ as Preoperative Predictors of the Outcome of Tonsillectomy. EAR, NOSE & THROAT JOURNAL 2021; 100:822S-827S. [PMID: 32182134 DOI: 10.1177/0145561320910682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Tonsillectomy (TE) and tonsillotomy (TO) due to recurrent episodes of acute tonsillitis (RAT) belong to the most frequent surgical procedures. However, an adequate objective marker predicting the outcome of TE/TO preoperatively is missing. METHODS Patients with RAT who underwent TE/TO (n = 31) were included in this pilot study. A panel of cytokines and chemokines in serum and saliva were determined preoperatively. Health-related quality of life was assessed pre- and postoperatively by the Tonsillectomy Outcome Inventory-14. RESULTS Health-related quality of life improved significantly after surgery. Increased serum levels of interleukin-8 (IL-8) and interferon gamma (IFN-γ) are associated with a less successful outcome. No correlation between the number of acute tonsillitis episodes and the health-related quality of life after TE or TO could be observed. CONCLUSIONS Tonsillectomy and TO improve health-related quality of life independently from the number of past acute tonsillitis episodes. Interleukin-8 and IFN-γ in serum may serve as promising markers, predicting the benefit of TE or TO for patients preoperatively.
Collapse
Affiliation(s)
- Alicia Seethaler
- Department of Otorhinolaryngology-Head and Neck Surgery, 155983University Hospital Münster, Germany
| | - Markus Stenner
- Department of Otorhinolaryngology-Head and Neck Surgery, 155983University Hospital Münster, Germany
| | - Annika McNally
- Institute of Immunology, 155983University Hospital Münster, Germany
| | - Claudia Rudack
- Department of Otorhinolaryngology-Head and Neck Surgery, 155983University Hospital Münster, Germany
| | - Johannes Roth
- Institute of Immunology, 155983University Hospital Münster, Germany
| | - Thomas Vogl
- Institute of Immunology, 155983University Hospital Münster, Germany
| | - Christoph Spiekermann
- Department of Otorhinolaryngology-Head and Neck Surgery, 155983University Hospital Münster, Germany
- Institute of Immunology, 155983University Hospital Münster, Germany
| |
Collapse
|
6
|
Guntinas-Lichius O, Geißler K, Asendorf T, Tostmann R, Löhler J. Tonsillectomy versus tonsillotomy for recurrent acute tonsillitis in children and adults (TOTO): study protocol for a randomized non-inferiority trial. Trials 2021; 22:479. [PMID: 34294123 PMCID: PMC8296750 DOI: 10.1186/s13063-021-05434-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 07/07/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Tonsillectomy is one of the most frequently performed surgeries in children and young adults worldwide. For decades, tonsillectomy was the surgical treatment of choice for recurrent acute tonsillitis. Tonsillotomy was used in some countries as an alternative to tonsillectomy only for the treatment of obstructive sleep apnea in young children. In recent years, an increase of tonsillotomy also to treat recurrent acute tonsillitis can be observed. Therefore, the German Institute for Quality and Efficiency in Health Care (IQWiG) was commissioned by the Federal Joint Committee (G-BA) to investigate whether tonsillotomy offers advantages compared to tonsillectomy. The meta-analysis of the IQWiG including studies until 2016 revealed that the long-term benefits and harms of tonsillotomy compared to tonsillectomy are unclear. Consequently, the G-BA performed a European call for a clinical trial. A consortium of the German Professional Association of ENT-surgeons (BVHNO), the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery (DGHNO-KHC), and the Jena University Hospital were finally selected to perform the TOTO study. METHODS TOTO is a multicenter, 1:1 two-arm, randomized non-blinded non-inferiority trial. Four hundred fifty-four patients ≥ 3 years of age will be randomly allocated to undergo either tonsillotomy or tonsillectomy as surgical treatment of recurrent acute tonsillitis. All participants will be followed up for a total of 24 months. The primary outcome is the number of sore throat days experienced over the 24-month follow-up. DISCUSSION TOTO is designed to evaluate the effectiveness and efficiency of tonsillectomy versus tonsillectomy for the management of patients with recurrent acute tonsillitis. Tonsil disease and surgery have a major impact on preschool and school children as well as on economically active young adults, with individual and societal costs through loss of school visits, earnings, and productivity. If tonsillotomy is at least as effective as tonsillectomy but with reduced morbidity, this would reduce costs to the healthcare system and society. TRIAL REGISTRATION German Clinical Trials Register DRKS00020823 . Registered on 04 September 2020.
Collapse
Affiliation(s)
- Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
- The German Study Centre for Otorhinolaryngology, Head and Neck Surgery (DSZ-HNO), Bonn, Germany.
| | - Katharina Geißler
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Thomas Asendorf
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Ralf Tostmann
- The German Study Centre for Otorhinolaryngology, Head and Neck Surgery (DSZ-HNO), Bonn, Germany
- Study Center, University Medical Center Göttingen, Göttingen, Germany
| | - Jan Löhler
- The German Study Centre for Otorhinolaryngology, Head and Neck Surgery (DSZ-HNO), Bonn, Germany
- Scientific Institute for Applied ENT-Research (WIAHNO) of the German Professional Association of ENT-Surgeons (BVHNO), Bad Bramstedt, Germany
| |
Collapse
|
7
|
Bou Sanayeh E, Idriss S, Farchakh Y, Hanna C, Hallit S, Romanos B. Monopolar electrocautery tip vs plasma ablation in tonsillotomy: A randomized case-control study comparing outcomes in pediatric population. Int J Pediatr Otorhinolaryngol 2021; 143:110655. [PMID: 33639493 DOI: 10.1016/j.ijporl.2021.110655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/25/2021] [Accepted: 02/14/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The objective of this study was to compare the low-priced monopolar electrocautery to the high-priced, worldwide used, plasma ablation in tonsillotomy among children aged between three and twelve years, suffering from obstructive breathing disorders (OBD), with respect to post-operative pain, bleeding and related morbidities. METHODS A randomized case-control study was conducted in the Eye and Ear Hospital International- Lebanon. 103 children aged between three and twelve years suffering from OBD secondary to tonsillar hypertrophy were randomly assigned into two groups. Post-operative pain was evaluated using age-adequate validated scales: "FLACC-R" (Face, Legs, Activity, Cry, Consolability-Revised) for children aged less than five years, and "Wong Baker faces" for older children. Additional post-operative outcomes were evaluated using Pain-PROM (Patient reported Pain-Related Outcome Measures) and TAHSI (Tonsil and Adenoid Health Status Instrument) scales. RESULTS Significantly, higher rates of patients who underwent tonsillotomy via plasma ablation technique used analgesics and had severe pain compared to the monopolar electrocautery group. A longer operative duration was significantly associated with higher pain scores, and the plasma ablation technique yielded significantly higher operative mean durations. 10 days post-operatively, a significantly higher percentage of children reported an overall high pain severity and more than expected overall pain when using the plasma ablation technique compared to the monopolar electrocautery one. Overall bleeding rates were similar. No difference was reported one month post-operatively. CONCLUSION When compared to plasma ablation, monopolar electrocautery, can provide the same efficiency in relieving OBD in healthy children, with equal overall bleeding rates, but significantly lower cost, operating time, pain scores and need for analgesics.
Collapse
Affiliation(s)
- Elie Bou Sanayeh
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.
| | - Samar Idriss
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon; Department of Otolaryngology Head and Neck Surgery, Eye and Ear International Hospital, Naccache, Lebanon
| | - Youssef Farchakh
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon; Department of Otolaryngology Head and Neck Surgery, Eye and Ear International Hospital, Naccache, Lebanon
| | - Charlie Hanna
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon; Department of Otolaryngology Head and Neck Surgery, Eye and Ear International Hospital, Naccache, Lebanon
| | - Souheil Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon; INSPECT-LB: National Institute of Public Health, Clinical Epidemiology and Toxicology, Beirut, Lebanon.
| | - Bassam Romanos
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon; Department of Otolaryngology Head and Neck Surgery, Eye and Ear International Hospital, Naccache, Lebanon.
| |
Collapse
|
8
|
Plath M, Sand M, Federspil PA, Plinkert PK, Baumann I, Zaoui K. Normative tonsillectomy outcome inventory 14 values as a decision-making tool for tonsillectomy. Eur Arch Otorhinolaryngol 2020; 278:1645-1651. [PMID: 32964263 PMCID: PMC8057992 DOI: 10.1007/s00405-020-06374-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/12/2020] [Indexed: 01/30/2023]
Abstract
Purpose The study aimed to determine normative values for the Tonsillectomy Outcome Inventory 14 (TOI-14) in a healthy middle-European cohort. We also compared these generated values with TOI-14 scores from a patient population with recurrent tonsillitis (RT) and explored the factorial structure of the TOI-14.
Methods We systematically studied the responses of healthy individuals (reference cohort) and patients with RT (clinical cohort) to the TOI-14 survey. The reference cohort contained 1000 participants, who were recruited using the Respondi panel for market and social science research. This subsample was quoted to the population distribution of the German Microcensus and selected from a non-probability panel. Tonsillitis patients were assessed before and 6 and 12 months after tonsillectomy. Data were analysed using principal component and exploratory factor analyses. Results The PCA revealed three TOI-14 domains (physiological, psychological and socio-economic), which explained 73% of the total variance. The reference cohort perceived a good quality of life (QOL) with a TOI-14 total score of 11.8 (physiological: 8.0, psychological: 5.8, and socio-economic subscale score: 13.9). TOI-14 scores were higher in the patient cohort, indicating that the TOI-14 discriminates between patients with RT and healthy individuals with no RT. Age and female gender significantly influenced the total TOI-14 score, especially in the psychological (age) and socio-economic (gender) subscales. Conclusion We have developed a set of normative values that, together with the TOI-14, can determine the disease burden indicating tonsillectomy.
Collapse
Affiliation(s)
- Michaela Plath
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Ruprecht-Karls-University, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Matthias Sand
- GESIS-Leibniz-Institute for the Social Sciences, Mannheim, Germany
| | - Philippe A Federspil
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Ruprecht-Karls-University, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Peter K Plinkert
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Ruprecht-Karls-University, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Ingo Baumann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Ruprecht-Karls-University, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Karim Zaoui
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Heidelberg, Ruprecht-Karls-University, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| |
Collapse
|