Milner Thomas D, Hilmi Omar, Marshall John, MacKenzie Kenneth
Queen Elizabeth University Hospital, Glasgow, UK.
University of Glasgow, Glasgow, UK.
Clin Otolaryngol. 2021 Jan;46(1):138-145. doi: 10.1111/coa.13608. Epub 2020 Sep 16.
The aim of this study was to assess the current post-tonsillectomy haemorrhage and return to theatre rates in Scotland.
National cross-sectional study.
Tonsillectomy outcomes data were collated for all NHS patients undergoing tonsillectomy in Scotland between 1998-2002 and 2013-2017.
Using Information Services Division (ISD) Scotland retrospective data, 30-day re-admission and 30-day return to theatre rates allowed an assessment of post-tonsillectomy haemorrhage rates. Data were validated through comparison with an audit conducted in NHS Greater Glasgow & Clyde between 2015 and 2016.
Tonsillectomy was performed in 27 819 patients between 1998 and 2002, and 23 184 patients between 2013 and 2017. 30-day re-admission rates increased considerably between the 1998-2002 and 2013-2017 cohorts, from 4.7% to 12.1% in paediatric patients, and 9.8%-19.9% in adult patients. Similarly, 30-day "return to theatre rates" increased between the two cohorts, from 1.2% to 1.7% in paediatric patients, and 3.6%-4.9% in adult patients. Re-admission and return to theatre rates were similar across Health Boards for both adult and paediatric tonsillectomies in each cohort.
Current 30-day re-admission and return to theatre rates are significantly higher than the majority of reported series to date. The rising rate of tonsillectomy haemorrhage between cohorts is likely to be multifactorial, possibly reflecting an underestimation of previous rates and the changing profile of the tonsillectomy patient. A detailed audit of current practice is needed to investigate these tonsillectomy outcomes, which are similar across all Health Boards in Scotland. Of most significance are the implications for accurate patient consent and non-elective ENT service provision.
本研究旨在评估苏格兰目前扁桃体切除术后出血情况及重返手术室率。
全国性横断面研究。
收集了1998 - 2002年以及2013 - 2017年期间在苏格兰接受扁桃体切除术的所有NHS患者的扁桃体切除术后结果数据。
利用苏格兰信息服务部（ISD）的回顾性数据，通过30天再入院率和30天重返手术室率来评估扁桃体切除术后出血率。数据通过与2015年至2016年在NHS大格拉斯哥和克莱德进行的一项审计进行比较来验证。
1998年至2002年期间有27819例患者接受了扁桃体切除术，2013年至2017年期间有23184例患者接受了扁桃体切除术。在1998 - 2002年队列与2013 - 2017年队列之间，30天再入院率显著增加，儿科患者从4.7%增至12.1%，成年患者从9.8%增至19.9%。同样，两个队列之间的30天“重返手术室率”也有所增加，儿科患者从1.2%增至1.7%，成年患者从3.6%增至4.9%。在每个队列中，成人和儿科扁桃体切除术的再入院率和重返手术室率在各卫生委员会之间相似。
目前的30天再入院率和重返手术室率显著高于迄今为止大多数报道的系列研究。队列之间扁桃体切除术后出血率上升可能是多因素导致的，可能反映了对既往发生率的低估以及扁桃体切除患者特征的变化。需要对当前的做法进行详细审计，以调查这些扁桃体切除术后结果，这些结果在苏格兰所有卫生委员会中相似。最重要的是对准确的患者知情同意和非选择性耳鼻喉科服务提供的影响。
