Bhattacharyya Neil, Shapiro Nina L
Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA
Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Otolaryngol Head Neck Surg. 2014 Dec;151(6):1055-60. doi: 10.1177/0194599814552647. Epub 2014 Oct 9.
To determine if disparities exist for revisits and complications after pediatric tonsillectomy.
Cross-sectional analysis of multistate databases.
Ambulatory surgery.
Cases of pediatric tonsillectomy with or without adenoidectomy were extracted from state ambulatory surgery databases and linked to state emergency department databases and inpatient databases for California, Iowa, Florida, and New York for 2010 and 2011. Revisit rates and diagnoses within 14 days were analyzed for potential associations of these complications with sex, race, and median household income quartile.
There were 79,520 cases of pediatric tonsillectomy that were extracted (50.3% male; mean age, 7.5 years). Overall, 6419 patients (8.1%) incurred a revisit after the procedure. Revisit rates for posttonsillectomy bleeding, acute pain, and fever/dehydration were 2.1%, 1.5%, and 2.2%, respectively. On multivariate analysis, increasing household income quartile was significantly associated with a decreasing rate of all complications: revisits (odds ratio [OR], 0.87; 95% confidence interval [CI], 0.84-0.89), posttonsillectomy bleeding (OR, 0.91; 95% CI, 0.86-0.96), acute pain (OR, 0.79; 95% CI, 0.74-0.84), and fever/dehydration (OR, 0.93; 95% CI, 0.89-0.98). Female sex was associated with a decreased rate of posttonsillectomy hemorrhaging (OR, 0.81; 95% CI, 0.73-0.91). Black and Hispanic children had an increased risk for a revisit after tonsillectomy (OR, 1.11; 95% CI, 1.01-1.22; and OR, 1.17; 95% CI, 1.09-1.26, respectively) and increased odds for acute pain at the revisit (OR, 1.36; 95% CI, 1.10-1.67; and OR, 1.34; 95% CI, 1.14-1.57, respectively) relative to white children. Race was not associated with the rate of hemorrhage posttonsillectomy.
Significant disparities, particularly with respect to household income, exist in the incidence of revisits and complications after pediatric tonsillectomy. The disparate burden of increased revisits and acute pain diagnoses after tonsillectomy deserve further attention.
确定小儿扁桃体切除术后复诊和并发症是否存在差异。
对多州数据库进行横断面分析。
门诊手术。
从加利福尼亚州、爱荷华州、佛罗里达州和纽约州的州门诊手术数据库中提取小儿扁桃体切除术（伴或不伴腺样体切除术）病例，并与2010年和2011年的州急诊科数据库及住院数据库相链接。分析14天内的复诊率和诊断结果，以探讨这些并发症与性别、种族和家庭收入中位数四分位数之间的潜在关联。
共提取了79520例小儿扁桃体切除术病例（男性占50.3%；平均年龄7.5岁）。总体而言，6419例患者（8.1%）术后进行了复诊。扁桃体切除术后出血、急性疼痛和发热/脱水的复诊率分别为2.1%、1.5%和2.2%。多因素分析显示，家庭收入四分位数增加与所有并发症发生率降低显著相关：复诊（比值比[OR]，0.87；95%置信区间[CI]，0.84 - 0.89）、扁桃体切除术后出血（OR，0.91；95% CI，0.86 - 0.96）、急性疼痛（OR，0.79；95% CI，0.74 - 0.84）和发热/脱水（OR，0.93；95% CI，0.89 - 0.98）。女性性别与扁桃体切除术后出血率降低相关（OR，0.81；95% CI，0.73 - 0.91）。黑人和西班牙裔儿童扁桃体切除术后复诊风险增加（OR分别为1.11；95% CI，1.01 - 1.22和OR，1.17；95% CI，1.09 - 1.26），复诊时急性疼痛的几率增加（OR分别为1.36；95% CI，1.10 - 1.67和OR，1.34；95% CI，1.14 - 1.57），相对于白人儿童。种族与扁桃体切除术后出血率无关。
小儿扁桃体切除术后复诊和并发症的发生率存在显著差异，尤其是在家庭收入方面。扁桃体切除术后复诊增加和急性疼痛诊断的差异负担值得进一步关注。
