Hsueh Wan-Yi, Hsu Wei-Chung, Ko Jenq-Yuh, Yeh Te-Huei, Lee Chia-Hsuan, Kang Kun-Tai
Department of Otolaryngology, Hsinchu Cathay General Hospital, Hsinchu, Taiwan; School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan; Department of Biomedical Engineering, Yuanpei University of Medical Technology, Hsinchu, Taiwan.
Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; National Taiwan University, College of Medicine, Taiwan.
Int J Pediatr Otorhinolaryngol. 2018 May;108:55-62. doi: 10.1016/j.ijporl.2018.02.021. Epub 2018 Feb 15.
Tonsil surgery in children is a common surgical procedure, and is mostly performed as an inpatient procedure in Taiwan. This study elucidates the epidemiology and postoperative hemorrhage of inpatient tonsillectomies in Taiwanese children.
This study used the Taiwan National Health Insurance Research Database for analysis. From 1997 to 2012, all in-hospital children (aged <18 years) who underwent tonsillectomies were identified through the International Codes of Diseases (9th Revision). Incidence rates and trends of inpatient pediatric tonsillectomies during the study period were identified. Major complications, including readmission, reoperation, and mortality were identified. The factors associated with major complications were analyzed.
From 1997 to 2012, 17326 children received inpatient tonsillectomies (mean age, 8.6 ± 3.8 y; 65% boys). The overall incidence rate was 20.6 per 100,000 children. The incidence rate was highest in children who were 6-8 years of age, and boys exhibited a higher rate than girls (P < 0.001). Longitudinal data indicated that the incidence rate increased from 1997 (15.7/100,000 children) to 2012 (19.2/100,000 children) (P trend < 0.001). The proportions of readmission for any reason, readmission for bleeding, and reoperation were 1.8%, 0.9%, and 0.3%, respectively. No mortality occurred within 30 days of the tonsillectomy. A multivariable logistic model indicated that toddlers were associated with an increased risk of readmission for any reason (OR, 2.70; 95% CI 1.60-4.56), and adolescents were at risk of bleeding-related readmission (OR, 2.81; 95% CI 1.91-4.14) and reoperation (OR, 2.86; 95% CI 1.47-5.55). Children with comorbidities (OR, 3.14; 95% CI 1.93-5.09) or a surgical indication of tumor (OR, 11.73; 95% CI 4.93-27.91) had a higher risk of readmission. The use of nonsteroidal anti-inflammatory drugs or steroids is associated with an increased risk of readmission or reoperation. Moreover, concurrent procedures (i.e., adenoidectomy, ear surgery, or nasal surgery) did not increase the risk of readmission or reoperation.
The incidence rate and indications of obstructive sleep disorders for inpatient pediatric tonsillectomy increased during 1997-2012 in Taiwan. Postoperative readmission and reoperation were rare. Age, surgical indication, comorbidities, and drug administration were associated with readmission or reoperation in this study cohort.
儿童扁桃体手术是一种常见的外科手术，在台湾大多作为住院手术进行。本研究阐明了台湾儿童住院扁桃体切除手术的流行病学情况及术后出血情况。
本研究使用台湾国民健康保险研究数据库进行分析。从1997年至2012年，通过国际疾病分类（第九版）识别所有接受扁桃体切除手术的住院儿童（年龄<18岁）。确定研究期间住院儿童扁桃体切除手术的发病率及趋势。识别主要并发症，包括再次入院、再次手术和死亡情况。分析与主要并发症相关的因素。
1997年至2012年，17326名儿童接受了住院扁桃体切除手术（平均年龄8.6±3.8岁；65%为男孩）。总体发病率为每10万名儿童中有20.6例。发病率在6至8岁儿童中最高，男孩发病率高于女孩（P<0.001）。纵向数据表明，发病率从1997年的每10万名儿童中有15.7例增加到2012年的每10万名儿童中有19.2例（P趋势<0.001）。因任何原因再次入院、因出血再次入院及再次手术的比例分别为1.8%、0.9%和0.3%。扁桃体切除术后30天内无死亡病例。多变量逻辑模型表明，幼儿因任何原因再次入院的风险增加（比值比[OR]，2.70；95%置信区间[CI] 1.60 - 4.56），青少年有出血相关再次入院（OR，2.81；95% CI 1.91 - 4.14）及再次手术（OR，2.86；95% CI 1.47 - 5.55）的风险。患有合并症的儿童（OR，3.14；95% CI 1.93 - 5.09）或手术指征为肿瘤的儿童（OR，11.73；95% CI 4.93 - 27.91）再次入院风险更高。使用非甾体抗炎药或类固醇与再次入院或再次手术风险增加相关。此外，同期手术（即腺样体切除术、耳部手术或鼻部手术）并未增加再次入院或再次手术的风险。
1997 - 2012年台湾住院儿童扁桃体切除手术治疗阻塞性睡眠障碍的发病率及手术指征有所增加。术后再次入院和再次手术情况罕见。本研究队列中，年龄、手术指征、合并症及药物使用与再次入院或再次手术相关。
