The Rotherham Foundation Trust, Moorgate Road, Rotherham.
Sheffield Teaching Hospitals, Glossop Road, Sheffield.
Ann R Coll Surg Engl. 2021 Mar;103(3):208-217. doi: 10.1308/rcsann.2020.7030.
Tonsillectomy is a common surgical procedure performed chiefly for recurrent tonsillitis. The Scottish Intercollegiate Guidance Network (SIGN) introduced guidelines in 1998 to improve patient selection for tonsillectomy and reduce the potential harm to patients from surgical complications such as haemorrhage. Since the introduction of the guidance, the number of admissions for tonsillitis and its complications has increased. National Hospital Episode Statistics over a 20-year period were analysed to assess the trends in tonsillectomy, post-tonsillectomy haemorrhage, tonsillitis and its complications with reference to the guidance, procedures of limited clinical value and the associated costs and benefits.
A literature search was conducted via PubMed and the Cochrane Library to identify relevant research. Hospital Episode Statistics data were interrogated and relevant data compared over time to assess trends related to the implementation of national guidance.
Over the period analysed, the incidence of deep neck space infections has increased almost five-fold, mediastinitis ten-fold and peritonsillar abscess by 1.7-fold compared with prior to SIGN guidance. Following procedures of limited clinical value implementation, the incidence of deep neck space infections has increased 2.4-fold, mediastinitis 4.1-fold and peritonsillar abscess 1.4-fold compared with immediately prior to clinical commissioning group rationing. The rate of tonsillectomy and associated haemorrhage (1-2%) has remained relatively constant at 46,299 (1999) compared with 49,447 (2009) and 49,141 (2016), despite an increase in the population of England by seven million over the 20-year period.
The rise in admissions for tonsillitis and its complications appears to correspond closely to the date of SIGN guidance and clinical commissioning group rationing of tonsillectomy and is on the background of a rise in the population of the UK. The move towards daycase tonsillectomy has reduced bed occupancy after surgery but this has been counteracted by an increase in admissions for tonsillitis and deep neck space infections, sometimes requiring lengthy intensive care stays and a protracted course of rehabilitation. The total cost of treating the complications of tonsillitis in England in 2017 is estimated to be around £73 million. The cost of tonsillectomy and treating post-tonsillectomy haemorrhage is £56 million by comparison. The total cost per annum for tonsillectomy prior to the introduction of SIGN guidance was estimated at £71 million with tonsillitis and its complications accounting for a further £8 million.
扁桃体切除术是一种常见的手术，主要用于治疗复发性扁桃体炎。苏格兰校际指导网络（SIGN）于 1998 年发布了指南，以改善扁桃体切除术患者的选择，并减少手术并发症（如出血）对患者的潜在危害。自指南发布以来，扁桃体炎及其并发症的住院人数有所增加。对 20 年来的国家住院患者统计数据进行分析，以评估与指南、临床价值有限的程序以及相关成本和收益相关的扁桃体切除术、扁桃体切除术后出血、扁桃体炎及其并发症的趋势。
通过 PubMed 和 Cochrane 图书馆进行文献检索，以确定相关研究。对住院患者统计数据进行查询，并随时间比较相关数据，以评估与国家指南实施相关的趋势。
在分析期间，与 SIGN 指南发布前相比，深部颈间隙感染的发病率增加了近五倍，纵隔炎增加了十倍，扁桃体周围脓肿增加了 1.7 倍。在实施临床价值有限的程序后，深部颈间隙感染的发病率增加了 2.4 倍，纵隔炎增加了 4.1 倍，扁桃体周围脓肿增加了 1.4 倍，与临床委托组配给前相比。尽管在 20 年期间，英格兰的人口增加了 700 万，但扁桃体切除术及其相关出血（1-2%）的比例相对稳定，分别为 46299（1999 年）、49447（2009 年）和 49141（2016 年）。
扁桃体炎及其并发症的住院人数增加似乎与 SIGN 指南和临床委托组扁桃体切除术的配给日期密切相关，并且是在英国人口增加的背景下发生的。向日间扁桃体切除术的转变减少了手术后的床位占用，但这被扁桃体炎和深部颈间隙感染住院人数的增加所抵消，有时需要长时间的重症监护和长期的康复过程。据估计，2017 年英格兰治疗扁桃体炎并发症的总费用约为 7300 万英镑。相比之下，扁桃体切除术和治疗扁桃体切除术后出血的费用为 5600 万英镑。在 SIGN 指南发布之前，每年扁桃体切除术的总费用估计为 7100 万英镑，扁桃体炎及其并发症占另外 800 万英镑。
