Melbourne Integrative Genomics, University of Melbourne, Parkville, Victoria, Australia.
Centre for Social Evolution, Department of Biology, University of Copenhagen, Copenhagen, Denmark.
JAMA Otolaryngol Head Neck Surg. 2018 Jul 1;144(7):594-603. doi: 10.1001/jamaoto.2018.0614.
Surgical removal of adenoids and tonsils to treat obstructed breathing or recurrent middle-ear infections remain common pediatric procedures; however, little is known about their long-term health consequences despite the fact that these lymphatic organs play important roles in the development and function of the immune system.
To estimate long-term disease risks associated with adenoidectomy, tonsillectomy, and adenotonsillectomy in childhood.
DESIGN, SETTING, AND PARTICIPANTS: A population-based cohort study of up to 1 189 061 children born in Denmark between 1979 and 1999 and evaluated in linked national registers up to 2009, covering at least the first 10 and up to 30 years of their life, was carried out. Participants in the case and control groups were selected such that their health did not differ significantly prior to surgery.
Participants were classified as exposed if adenoids or tonsils were removed within the first 9 years of life.
The incidence of disease (defined by International Classification of Diseases, Eighth Revision [ICD-8] and Tenth Revision [ICD-10] diagnoses) up to age 30 years was examined using stratified Cox proportional hazard regressions that adjusted for 18 covariates, including parental disease history, pregnancy complications, birth weight, Apgar score, sex, socioeconomic markers, and region of Denmark born.
A total of up to 1 189 061 children were included in this study (48% female); 17 460 underwent adenoidectomy, 11 830 tonsillectomy, and 31 377 adenotonsillectomy; 1 157 684 were in the control group. Adenoidectomy and tonsillectomy were associated with a 2- to 3-fold increase in diseases of the upper respiratory tract (relative risk [RR], 1.99; 95% CI, 1.51-2.63 and RR, 2.72; 95% CI, 1.54-4.80; respectively). Smaller increases in risks for infectious and allergic diseases were also found: adenotonsillectomy was associated with a 17% increased risk of infectious diseases (RR, 1.17; 95% CI, 1.10-1.25) corresponding to an absolute risk increase of 2.14% because these diseases are relatively common (12%) in the population. In contrast, the long-term risks for conditions that these surgeries aim to treat often did not differ significantly and were sometimes lower or higher.
In this study of almost 1.2 million children, of whom 17 460 had adenoidectomy, 11 830 tonsillectomy, and 31 377 adenotonsillectomy, surgeries were associated with increased long-term risks of respiratory, infectious, and allergic diseases. Although rigorous controls for confounding were used where such data were available, it is possible these effects could not be fully accounted for. Our results suggest it is important to consider long-term risks when making decisions to perform tonsillectomy or adenoidectomy.
腺样体和扁桃体切除术用于治疗呼吸阻塞或复发性中耳感染，仍是常见的儿科手术；然而，尽管这些淋巴器官在免疫系统的发育和功能中起着重要作用，但人们对其长期健康后果知之甚少。
评估儿童腺样体切除术、扁桃体切除术和腺样体扁桃体切除术相关的长期疾病风险。
设计、地点和参与者：对 1979 年至 1999 年期间在丹麦出生的至多 1189061 名儿童进行了一项基于人群的队列研究，通过链接的国家登记册进行了评估，覆盖了他们生命的前 10 年至 30 年，至少进行了一次评估。病例组和对照组的参与者是根据手术前其健康状况没有显著差异选择的。
如果腺样体或扁桃体在生命的前 9 年内被切除，则将参与者分类为暴露。
使用分层 Cox 比例风险回归来检查 30 岁前的疾病发生率（通过国际疾病分类第 8 版[ICD-8]和第 10 版[ICD-10]诊断定义），该回归调整了 18 个协变量，包括父母病史、妊娠并发症、出生体重、阿普加评分、性别、社会经济指标和丹麦出生地区。
本研究共纳入至多 1189061 名儿童（48%为女性）；17460 名接受了腺样体切除术，11830 名接受了扁桃体切除术，31377 名接受了腺样体扁桃体切除术；1157684 名作为对照组。腺样体切除术和扁桃体切除术与上呼吸道疾病风险增加 2-3 倍相关（相对风险[RR]，1.99；95%CI，1.51-2.63 和 RR，2.72；95%CI，1.54-4.80；分别）。还发现了传染性和过敏性疾病风险的较小增加：腺样体扁桃体切除术与传染性疾病风险增加 17%相关（RR，1.17；95%CI，1.10-1.25），这对应于 2.14%的绝对风险增加，因为这些疾病在人群中相对常见（12%）。相比之下，这些手术旨在治疗的疾病的长期风险通常没有显著差异，有时更高或更低。
在这项对近 120 万名儿童的研究中，17460 名儿童接受了腺样体切除术，11830 名儿童接受了扁桃体切除术，31377 名儿童接受了腺样体扁桃体切除术，这些手术与呼吸道、传染性和过敏性疾病的长期风险增加相关。尽管在有此类数据的地方使用了严格的混杂控制，但这些影响可能无法完全解释。我们的研究结果表明，在决定进行扁桃体切除术或腺样体切除术时，考虑长期风险很重要。
