Takwoingi Y M, Shykhon M, Wake M
Department of Otolaryngology - Head and Neck Surgery, Heartlands Hospital, Birmingham, UK.
J Laryngol Otol. 2007 Oct;121(10):968-72. doi: 10.1017/S002221510700597X. Epub 2007 Feb 26.
To determine whether the introduction of a 14-day post-tonsillectomy analgesic regime would be associated with a statistically significant decrease in readmission rate.
A comparative study of tonsillectomy patients over two study periods. A retrospective review was undertaken of 342 patients (group one, five-day analgesic regime) who had undergone tonsillectomy. A prospective study was undertaken of 228 patients (group two, 14-day analgesic regime). The readmission rates for the two study periods were compared.
The median age of group one patients was 8.1 years (range, zero to 43 years). In this group, 'cold steel' dissection was performed in 177 patients (52 per cent) and bipolar dissection in 165 patients (48 per cent); seven patients suffered reactionary haemorrhage, all from the cold steel dissection group. The median age of group two patients was 8.0 years (range, one to 47 years). In this group, cold steel dissection was performed in 103 patients (45 per cent) and bipolar dissection in 125 patients (55 per cent); there were no cases of reactionary haemorrhage. The readmission rate for group one was 9.9 per cent (34 patients), with 2.1 per cent (seven patients) returning to the operating theatre for control of haemorrhage. In group two, 8.8 per cent (20 patients) were readmitted and 1.3 per cent (three patients) returned to the operating theatre. The main reason for readmission was secondary haemorrhage: 9.1 per cent from group one and 8.3 per cent from group two. No significant difference in readmission was found between the 5-day analgesia and the 14-day analgesia groups (p=0.443). However, there was a significant difference between the diathermy and cold steel dissection groups (p<0.001). Patients undergoing bipolar diathermy were almost six times more likely to be readmitted than those undergoing cold steel dissection (odds ratio 5.78). The average time to readmission after tonsillectomy did not significantly differ between the two groups.
The post-tonsillectomy readmission rate was not affected by the duration of post-operative analgesia; however, operating technique did have an effect.
确定引入扁桃体切除术后14天镇痛方案是否会使再入院率出现具有统计学意义的下降。
对两个研究阶段的扁桃体切除患者进行对比研究。对342例接受扁桃体切除术的患者（第一组，5天镇痛方案）进行回顾性分析。对228例患者（第二组，14天镇痛方案）进行前瞻性研究。比较两个研究阶段的再入院率。
第一组患者的中位年龄为8.1岁（范围为0至43岁）。该组中，177例患者（52%）采用“冷钢”剥离术，165例患者（48%）采用双极剥离术；7例患者发生继发性出血，均来自冷钢剥离术组。第二组患者的中位年龄为8.0岁（范围为1至47岁）。该组中，103例患者（45%）采用冷钢剥离术，125例患者（55%）采用双极剥离术；无继发性出血病例。第一组的再入院率为9.9%（34例患者），其中2.1%（7例患者）返回手术室进行出血控制。第二组中，8.8%（20例患者）再次入院，1.3%（3例患者）返回手术室。再入院的主要原因是继发性出血：第一组为9.1%，第二组为8.3%。5天镇痛组和14天镇痛组之间的再入院率无显著差异（p = 0.443）。然而，透热疗法组和冷钢剥离术组之间存在显著差异（p < 0.001）。接受双极透热疗法的患者再入院的可能性几乎是接受冷钢剥离术患者的六倍（优势比5.78）。扁桃体切除术后再入院的平均时间在两组之间无显著差异。
扁桃体切除术后再入院率不受术后镇痛持续时间的影响；然而，手术技术确实有影响。
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