The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
Translational and Clinical Research Institute, Faculty of Medical Sciences, University of Newcastle upon Tyne, Newcastle upon Tyne, UK.
Clin Otolaryngol. 2021 May;46(3):552-561. doi: 10.1111/coa.13707. Epub 2021 Jan 19.
To assess the safety of paediatric tonsillectomy procedures conducted in NHS hospitals in England between 2008 and 2019.
Retrospective observational cohort study using Hospital Episode Statistics (HES) data.
Acute NHS trusts in England conducting paediatric tonsillectomy procedures.
Children (≤16 years old) undergoing bilateral tonsillectomy.
Number of tonsillectomies performed per year by procedural method. In-hospital complications including return to theatre for arrest of haemorrhage. Readmission within 28 days, including those for pain, haemorrhage and surgical arrest of haemorrhage. Long-term outcomes: all-cause mortality, revision tonsillectomy.
A total of 318 453 paediatric tonsillectomies were performed from 2008 to 2019:278,772 dissection (87.5%) and 39 681 coblation (12.5%). The proportion of tonsillectomy performed using coblation increased from 7% in 2008/9 to 27% in 2018/9. Five patients died in hospital (including 4 due to respiratory complications). In-hospital complications occurred in 4202 children (1.3%), with the most frequent being haemorrhage. Within 28 days of tonsillectomy, 28 170 patients (8.8%) were readmitted and 7 deaths occurred. Readmission rates for haemorrhage and pain have increased since 2008. The proportion of children undergoing revision tonsillectomy procedures within 5 years following coblation tonsillectomy (1.4%) was approximately double that of dissection (0.6%).
Clinical practice of paediatric tonsillectomy has changed in England over the past 11 years. The overall mortality rate associated with the procedure is 0.0037%. Differences in outcomes have been identified for different procedural methods. However, routine administrative data are limited in differentiating procedural detail (eg we are unable to differentiate intra or extra-capsular techniques from current clinical coding of tonsillectomy procedures). Therefore, prospective national data collection or more granular clinical coding is essential to capture relative outcomes of the different tonsillectomy methods and techniques being used in the NHS.
评估 2008 年至 2019 年期间英格兰国民保健服务（NHS）医院实施的小儿扁桃体切除术的安全性。
使用医院入院统计数据（HES）进行回顾性观察性队列研究。
在英格兰进行小儿扁桃体切除术的急性 NHS 信托基金。
接受双侧扁桃体切除术的儿童（≤16 岁）。
每年按手术方法进行的扁桃体切除术数量。包括因出血需返回手术室止血的院内并发症。28 天内再入院，包括因疼痛、出血和手术止血而再入院。长期结果：全因死亡率、扁桃体切除术修正。
2008 年至 2019 年共进行了 318453 例小儿扁桃体切除术：278772 例为剥离术（87.5%）和 39681 例为等离子切除术（12.5%）。使用等离子切除术进行扁桃体切除术的比例从 2008/9 年的 7%增加到 2018/9 年的 27%。有 5 名患者在医院死亡（包括 4 例因呼吸并发症死亡）。有 4202 名儿童（1.3%）发生院内并发症，最常见的是出血。扁桃体切除术后 28 天内，28170 名患者（8.8%）再次入院，有 7 人死亡。自 2008 年以来，出血和疼痛的再入院率有所增加。等离子切除术后 5 年内行扁桃体切除术修正术的患儿比例（1.4%）约为剥离术的两倍（0.6%）。
过去 11 年来，英格兰小儿扁桃体切除术的临床实践发生了变化。该手术的总体死亡率为 0.0037%。不同手术方法的结果存在差异。然而，常规行政数据在区分手术细节方面存在局限性（例如，我们无法从目前的扁桃体切除术临床编码中区分囊内或囊外技术）。因此，需要进行全国范围的前瞻性数据收集或更精细的临床编码，以捕捉国民保健服务中使用的不同扁桃体切除术方法和技术的相对结果。
