Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI.
J Pediatr. 2015 Mar;166(3):607-12.e5. doi: 10.1016/j.jpeds.2014.11.009. Epub 2014 Dec 16.
To describe the clinical spectrum and frequency of acute care revisits after tonsillectomy in a population-based sample from a single state in the US.
We used California state discharge databases from 2009 to 2011 to retrospectively identify retrospectively routine tonsillectomy discharges in residents <25 years of age and to establish record linkage to revisits within 30 days at ambulatory surgery, inpatient, and emergency department facilities statewide. Percentages and descriptive statistics were sample-weighted, and revisit rates were adjusted for demographic factors, expected payer, chronic conditions, surgical indication, facility type, and clustering.
Records were available for 35 085 index tonsillectomies, most of which were performed at hospital-owned ambulatory and inpatient facilities. There were 4944 associated revisits: 3761 (75.9%) treat-and-release emergency room visits, 816 (17.1%) inpatient admissions, and 367 (7.0%) ambulatory surgery visits. Most revisits (3225 [67.7%]) were unrelated to bleeding; these typically occurred early (mode, day 2) and were commonly associated with diagnosis codes indicating pain, nausea/vomiting, or dehydration. Crude all-cause revisit and readmission rates were 10.5% and 2.1%, respectively. Adjusted all-cause revisit rates (range, 8.6%-24.5%) were lowest in young children, increased in adolescents, and peaked in young adults. Adjusted bleeding-related revisit rates increased abruptly in adolescents and reached 13.9% in males (6.8% in females, P < .001) ages 20-24 years.
Acute care revisits after tonsillectomy performed at predominantly hospital-owned facilities in California are common and strongly age-related. Most revisits are early treat-and-release outpatient encounters, and these are usually associated with potentially preventable problems such as pain, nausea and vomiting, and dehydration.
描述美国加利福尼亚州单州人群中基于人群的样本中扁桃体切除术后急性护理复诊的临床谱和频率。
我们使用 2009 年至 2011 年加利福尼亚州出院数据库，回顾性地确定年龄<25 岁的居民常规扁桃体切除术出院情况，并建立全州范围内在门诊手术、住院和急诊设施中 30 天内复诊的记录链接。百分比和描述性统计数据进行了样本加权，并且根据人口统计学因素、预期支付者、慢性疾病、手术指征、设施类型和聚类调整了复诊率。
共有 35085 例扁桃体切除术的记录可用，其中大多数是在医院拥有的门诊和住院设施中进行的。有 4944 例相关复诊：3761 例（75.9%）为治疗后释放急诊就诊，816 例（17.1%）为住院入院，367 例（7.0%）为门诊手术就诊。大多数复诊（3225 例[67.7%]）与出血无关；这些通常发生在早期（模式，第 2 天），通常与表明疼痛、恶心/呕吐或脱水的诊断代码相关。未经调整的全因复诊和再入院率分别为 10.5%和 2.1%。调整后的全因复诊率（范围为 8.6%-24.5%）在幼儿中最低，在青少年中增加，在年轻成年人中达到峰值。调整后的与出血相关的复诊率在青少年中急剧增加，在 20-24 岁的男性中达到 13.9%（女性为 6.8%，P<0.001）。
在加利福尼亚州主要由医院拥有的设施进行的扁桃体切除术后，急性护理复诊很常见，并且与年龄密切相关。大多数复诊是早期治疗后释放的门诊就诊，通常与潜在可预防的问题相关，如疼痛、恶心和呕吐以及脱水。
