Fedeli Ugo, Marchesan Maria, Avossa Francesco, Zambon Francesco, Andretta Marilisa, Baussano Iacopo, Spolaore Paolo
SER-Epidemiological Department, Veneto Region, Castelfranco Veneto, TV, Italy.
BMC Health Serv Res. 2009 Feb 7;9:25. doi: 10.1186/1472-6963-9-25.
Despite national guidelines in 2003 aimed at limiting the recourse to tonsillectomy and/or adenoidectomy (A/T), the latter are among the most frequent pediatric surgeries performed in Italy. Aim of the study is to investigate variability of A/T rates among children of the Veneto Region, Italy.
All discharges of Veneto residents with Diagnosis-Related Groups 57-60 and ICD9-CM intervention codes 28.2 (tonsillectomy), 28.3 (adenotonsillectomy), 28.6 (adenoidectomy) were selected in the period 2000-2006 for a descriptive analysis. A multilevel Poisson regression model was applied to estimate Incidence Rate Ratios (IRR) with 95% Confidence Intervals (CI) for A/T surgery among children aged 2-9 years in 2004-2006, while taking into account clustering of interventions within the 21 Local Health Units.
Through 2000-2006, the overall number of A/T surgeries decreased (-8%); there was a decline of adenoidectomies (-20%) and tonsillectomies (-8%), whereas adenotonsillectomies raised (+18%). Analyses on children aged 2-9 resulted in an overall rate of 14.4 surgeries per 1000 person-years (16.1 among males and 12.5 among females), with a wide heterogeneity across Local Health Units (range 8.1-27.6). At random intercept Poisson regression, while adjusting for sex and age, intervention rates were markedly lower among foreign than among Italian children (IRR = 0.57, CI 0.53-0.61). A/T rates in the 10-40 age group (mainly tonsillectomies) computed for each Local Health Unit and introduced in the regression model accounted for 40% of the variance at Local Health Unit level of pediatric rates (mainly adenoidectomies and adenotonsillectomies).
A/T rates in the Veneto Region, especially adenoidectomies among children aged 2-9 years, remain high notwithstanding a decrease through 2000-2006. A wide heterogeneity according to nationality and Local Health Units is evident. The propensity to A/T surgery of each Local Health Unit is similar in different age groups and for different surgical indications.
尽管2003年出台了旨在限制扁桃体切除术和/或腺样体切除术（A/T）使用的国家指南，但这两种手术仍是意大利最常见的儿科手术。本研究旨在调查意大利威尼托地区儿童中A/T手术率的差异。
选取2000 - 2006年期间威尼托地区居民所有诊断相关分组为57 - 60且ICD9 - CM干预编码为28.2（扁桃体切除术）、28.3（腺样体扁桃体切除术）、28.6（腺样体切除术）的出院病例进行描述性分析。应用多水平泊松回归模型估计2004 - 2006年2 - 9岁儿童A/T手术的发病率比（IRR）及95%置信区间（CI），同时考虑21个地方卫生单位内干预措施的聚集性。
2000 - 2006年期间，A/T手术总数下降了8%；腺样体切除术下降了20%，扁桃体切除术下降了8%，而腺样体扁桃体切除术增加了18%。对2 - 9岁儿童的分析显示，总体手术率为每1000人年14.4例（男性为16.1例，女性为12.5例），各地方卫生单位之间存在很大差异（范围为8.1 - 27.6）。在随机截距泊松回归分析中，在调整性别和年龄后，外国儿童的干预率明显低于意大利儿童（IRR = 0.57，CI 0.53 - 0.61）。为每个地方卫生单位计算并引入回归模型的10 - 40岁年龄组（主要是扁桃体切除术）的A/T手术率占儿科手术率（主要是腺样体切除术和腺样体扁桃体切除术）地方卫生单位水平方差的40%。
尽管2000 - 2006年有所下降，但威尼托地区的A/T手术率，尤其是2 - 9岁儿童的腺样体切除术率仍然很高。不同国籍和地方卫生单位之间存在明显差异。各地方卫生单位对A/T手术的倾向在不同年龄组和不同手术指征中相似。
