Bhattacharyya Neil
Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA.
Am J Otolaryngol. 2015 Mar-Apr;36(2):249-53. doi: 10.1016/j.amjoto.2014.11.004. Epub 2014 Nov 20.
Determine if disparities exist for revisit complications after adult tonsillectomy.
Cases of adult tonsillectomy were extracted from the state ambulatory surgery databases and linked to the state emergency department databases and inpatient databases for California, Iowa, Florida and New York for 2010 and 2011. Revisits within 14days for diagnoses of: post-tonsillectomy bleeding, acute pain and nausea/vomiting/dehydration were determined and analyzed for associations of these complications with age, sex, race, median household income and comorbidity score.
Among 17,836 tonsillectomies (63.7% female; mean age, 29.0years), revisit rates for post-tonsillectomy bleeding, acute pain and fever/dehydration were 5.1, 2.8 and 1.5%, respectively. On multivariate analysis, only female sex was associated with a lower post-tonsillectomy bleeding rate (odds, 0.48, p<0.001). Decreasing household income, female sex, black and Hispanic race were associated with increased revisits for acute pain (odds, 1.21, 1.49, 2.03 and 1.32, p≤0.002). Female sex was associated with an increased odds of a revisit for FNVD (odds, 1.94, p<0.001).
Significant disparities with respect to income and race exist in the incidence of revisits and potentially avoidable complications after adult tonsillectomy.
确定成人扁桃体切除术后再次就诊并发症是否存在差异。
从加利福尼亚州、爱荷华州、佛罗里达州和纽约州的门诊手术数据库中提取成人扁桃体切除术病例，并与2010年和2011年的急诊数据库及住院数据库相链接。确定并分析术后14天内因扁桃体切除术后出血、急性疼痛和恶心/呕吐/脱水等诊断而再次就诊的情况，以及这些并发症与年龄、性别、种族、家庭收入中位数和合并症评分之间的关联。
在17836例扁桃体切除术中（女性占63.7%；平均年龄29.0岁），扁桃体切除术后出血、急性疼痛和发热/脱水的再次就诊率分别为5.1%、2.8%和1.5%。多因素分析显示，只有女性与较低的扁桃体切除术后出血率相关（比值比为0.48，p<0.001）。家庭收入降低、女性、黑人和西班牙裔种族与急性疼痛再次就诊增加相关（比值比分别为1.21、1.49、2.03和1.32，p≤0.002）。女性与因恶心/呕吐/脱水再次就诊的几率增加相关（比值比为1.94，p<0.001）。
成人扁桃体切除术后再次就诊率及潜在可避免并发症的发生率在收入和种族方面存在显著差异。
