Department of Head and Neck Surgery, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California, U.S.A.
Laryngoscope. 2015 Feb;125(2):457-61. doi: 10.1002/lary.24783. Epub 2014 Jun 17.
OBJECTIVES/HYPOTHESIS: Investigate the incidence and characteristics of revisits following ambulatory pediatric tonsillectomy/adenotonsillectomy.
Cross-sectional study using national databases.
Ambulatory pediatric (age <18.0 years) tonsillectomy or adenotonsillectomy cases were extracted from the 2010 State Ambulatory Surgery, Emergency Department, and Inpatient databases for New York, Florida, Iowa, and California. First and second revisits within the 14-day postoperative period were tabulated. Diagnoses, procedure codes, and mortality were examined.
There were 36,221 pediatric tonsillectomies/adenotonsillectomies (mean age 7.4 years, 51.4% male). Overall, 2,740 patients (7.6%) had a revisit after pediatric tonsillectomy; 402 patients (1.1%) had a second revisit. Among revisits, 6.3% revisited the ambulatory surgery center, 77.5% revisited the emergency department, and 16.2% were readmitted as an inpatient. Among all tonsillectomies, bleeding occurred in 2.0% and 0.5% within the first and second revisits, respectively. A second revisit had a statistically higher association with a primary bleeding diagnosis than the first revisit (P < .001). Among all cases, 0.75% underwent a surgical procedure for bleeding at a first revisit compared to 0.25% during a second revisit. Acute pain was the primary diagnosis in 18.4% and 11.2% of first and second revisits; fever/vomiting/dehydration were primary diagnoses in 28.2% and 17.9%, respectively. There were two mortalities (0.0055%) within the 14-day postoperative interval.
This large-scale analysis describes the current rates and diagnoses of revisits, hospital readmission, and surgical intervention following ambulatory pediatric tonsillectomy. Many revisits centered on pain control and dehydration, suggesting that more adequate symptom control may prevent a large proportion of revisits.
2b.
目的/假设：调查门诊小儿扁桃体切除术/腺样体切除术术后复诊的发生率和特点。
使用国家数据库进行的横断面研究。
从纽约、佛罗里达、爱荷华州和加利福尼亚州的 2010 年州门诊手术、急诊部和住院数据库中提取门诊小儿（年龄<18 岁）扁桃体切除术或腺样体切除术病例。记录术后 14 天内的首次和第二次复诊。检查诊断、手术代码和死亡率。
共有 36221 例小儿扁桃体切除术/腺样体切除术（平均年龄 7.4 岁，51.4%为男性）。总体而言，36221 例患儿中有 2740 例（7.6%）在小儿扁桃体切除术后复诊；402 例（1.1%）有第二次复诊。在复诊中，6.3%在门诊手术中心复诊，77.5%在急诊部复诊，16.2%住院。在所有扁桃体切除术病例中，首次和第二次复诊中分别有 2.0%和 0.5%发生出血。与第一次复诊相比，第二次复诊的主要诊断为出血的比例更高（P<0.001）。在所有病例中，首次复诊时因出血而行手术治疗的比例为 0.75%，而第二次复诊时为 0.25%。急性疼痛是首次和第二次复诊的主要诊断，分别占 18.4%和 11.2%；发热/呕吐/脱水分别是首次和第二次复诊的主要诊断，分别占 28.2%和 17.9%。在术后 14 天内有 2 例死亡（0.0055%）。
这项大规模分析描述了门诊小儿扁桃体切除术后复诊、住院再入院和手术干预的当前发生率和诊断。许多复诊是为了控制疼痛和脱水，这表明更充分的症状控制可能会预防很大一部分复诊。
2b。
