Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
Int J Pediatr Otorhinolaryngol. 2020 Nov;138:110338. doi: 10.1016/j.ijporl.2020.110338. Epub 2020 Sep 9.
Tonsillectomy is the second most common surgical procedure performed in pediatric otolaryngology. Multiple courses of antibiotics are usually prescribed prior to surgical intervention. Surgery is indicated when patients reach a certain number of infective episodes, or their obstructive symptoms warrant intervention. Little is known about the role of tonsillectomy on long term postoperative antibiotic use. Recently, our group published a retrospective case series that described the clinical characteristics and outcomes of children under the age of 16 years who underwent tonsillectomy. This study is a follow-up on this previous case series and its purpose is to determine whether tonsillectomy in this group of children led to a reduction in the number of antibiotics prescribed in the year following surgery.
Data were collected from the clinical records departments of two district health boards in Auckland, New Zealand. Hospital morbidity records were reviewed for all children younger than 16 years old, who underwent a tonsillectomy between December 2015 and December 2017 in the Auckland region. All antibiotics prescribed following surgery were obtained from New Zealand's national community prescribing database.
A total of 1538 children underwent tonsillectomy during the study period. Following surgery, antibiotics were prescribed to 828 (54%) patients at the time of discharge, with an average of 1.2 ± 0.1 courses in the year following surgery. This was significantly reduced compared to preoperative antibiotic intake (3.4 ± 0.1 courses) in the year preceding surgery (p < 0.001). Readmission within 30 days of discharge was not associated with increased antibiotic usage postoperatively. In the two weeks following surgery, 25% of patients were prescribed a course of antibiotics for a presumed postoperative infection.
These findings support the benefit of tonsillectomy in reducing antibiotic consumption in the year following surgery. Furthermore, it has highlighted areas of practice, such as perioperative antibiotic prescription, which can be improved to further reduce the prescription of antibiotics for children with tonsillar hyperplasia.
扁桃体切除术是小儿耳鼻喉科第二常见的手术。通常在手术干预前开具多疗程抗生素。当患者出现一定次数的感染发作或其阻塞症状需要干预时，即需要进行手术。扁桃体切除术对长期术后抗生素使用的作用知之甚少。最近，我们小组发表了一项回顾性病例系列研究，描述了 16 岁以下接受扁桃体切除术的儿童的临床特征和结局。本研究是对先前病例系列研究的后续研究，目的是确定该组儿童的扁桃体切除术是否导致术后一年开处抗生素的数量减少。
数据从新西兰奥克兰的两个地区卫生局的临床记录部门收集。回顾了 2015 年 12 月至 2017 年 12 月期间在奥克兰地区接受扁桃体切除术的所有 16 岁以下儿童的住院病历。从新西兰国家社区处方数据库中获取术后开处的所有抗生素。
在研究期间，共有 1538 名儿童接受了扁桃体切除术。手术后，828 名（54%）患者在出院时开具了抗生素，术后一年平均开处 1.2 ± 0.1 个疗程。与术前一年（p < 0.001）相比，这显著减少了。出院后 30 天内再次入院与术后抗生素使用增加无关。术后两周内，25%的患者因疑似术后感染而开处一个疗程的抗生素。
这些发现支持扁桃体切除术在减少术后一年抗生素使用方面的益处。此外，它还突出了围手术期抗生素处方等实践领域，可以进一步改进，以减少扁桃体肥大儿童抗生素的处方。
