Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
University Neurosurgical Center Holland, Leiden University Medical Center, Leiden, The Netherlands.
BMJ Open. 2021 Jul 1;11(7):e046840. doi: 10.1136/bmjopen-2020-046840.
In the past few decades, there has been an increase in high-quality studies providing evidence on the effectiveness of commonly performed procedures in paediatric otolaryngology. We believe that now is the time to re-evaluate the care process. We aimed to analyse (1) the regional variation in incidence and referrals of adenoidectomies, tonsillectomies and ventilation tube insertions in children in the Netherlands between 2016 and 2019, (2) whether regional surgical rates, referral rates and in-hospital surgical rates were associated with one another, and (3) the hospital variation in healthcare costs, which indicates the utilisation of resources.
Repeated cross-sectional analysis.
Four neighbouring Dutch provinces comprising 2.8 million inhabitants and 14 hospitals.
Children aged 0-15 years.
We analysed variation in regional surgical rates and referral rates per 1000 inhabitants and in-hospital surgical rates per 1000 clinic visitors, adjusted for age and socioeconomic status. Furthermore, the relationships between referral rates, regional surgical rates and in-hospital surgical rates were estimated. Lastly, variation in resource utilisation between hospitals was estimated.
Adenoidectomy rates differed sixfold between regions. Twofold differences were observed for adenotonsillectomy rates, ventilation tube insertion rates and referral rates. Referral rates were negatively associated with in-hospital surgical rates for adenotonsillectomies, but not for adenoidectomies and ventilation tube insertions. In-hospital surgical rates were positively associated with regional rates for adenoidectomies and adenotonsillectomies. Significant variation between hospitals was observed in costs for all resources.
We observed low variation in tonsillectomies and ventilation tube insertion and high variation in adenoidectomies. Indications for a tonsillectomy and ventilation tube insertion are well defined in Dutch guidelines, whereas this is not the case for an adenoidectomy. Lack of agreement on indications can be expected and high-quality effectiveness research is required to improve evidence-based guidelines on this topic.
在过去几十年中，越来越多的高质量研究提供了关于小儿耳鼻喉科常见手术有效性的证据。我们认为现在是重新评估治疗过程的时候了。我们旨在分析：（1）2016 年至 2019 年间荷兰儿童腺样体切除术、扁桃体切除术和通气管插入术的发病率和转诊率的地区差异；（2）区域手术率、转诊率和住院手术率之间是否存在相关性；（3）医院间医疗成本的差异，这表明了资源的利用情况。
重复横断面分析。
由四个毗邻的荷兰省份组成，拥有 280 万居民和 14 家医院。
0-15 岁的儿童。
我们分析了每 1000 名居民的区域手术率和转诊率以及每 1000 名门诊访客的住院手术率，同时调整了年龄和社会经济地位因素。此外，还估计了转诊率、区域手术率和住院手术率之间的关系。最后，估计了医院间资源利用的差异。
腺样体切除术的地区差异高达六倍。腺样体扁桃体切除术、通气管插入术和转诊率的差异也高达两倍。对于腺样体扁桃体切除术，转诊率与住院手术率呈负相关，但对于腺样体切除术和通气管插入术则不然。住院手术率与腺样体切除术和腺样体扁桃体切除术的区域率呈正相关。所有资源的成本在医院间存在显著差异。
我们观察到扁桃体切除术和通气管插入术的变化较小，而腺样体切除术的变化较大。荷兰指南中明确规定了扁桃体切除术和通气管插入术的适应证，而腺样体切除术则不然。预计会出现对适应证缺乏共识的情况，需要进行高质量的有效性研究，以改善该主题的循证指南。
