Department of Paediatrics, Monash University and The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Australia.
Melbourne Medical School, University of Melbourne, Melbourne, Australia.
J Otolaryngol Head Neck Surg. 2022 Jan 12;51(1):1. doi: 10.1186/s40463-021-00552-8.
Tonsillectomy, with or without adenoidectomy, is the leading reason for paediatric unplanned hospital readmission, some of which are potentially avoidable. Reducing unplanned hospital revisits would improve patient safety and decrease use of healthcare resources. This study aimed to describe the incidence, timing and risk factors for any surgery-related hospital revisits (both emergency presentation and readmission) following paediatric tonsillectomy and adenotonsillectomy in a large state-wide cohort.
We conducted a population-based cohort study using linked administrative datasets capturing all paediatric tonsillectomy and adenotonsillectomy surgeries performed between 2010 and 2015 in the state of Victoria, Australia. The primary outcome was presentation to the emergency department or hospital readmission within 30-day post-surgery.
Between 2010 and 2015, 46,583 patients underwent 47,054 surgeries. There was a total of 4758 emergency department presentations (10.11% total surgeries) and 2750 readmissions (5.84% total surgeries). Haemorrhage was the most common reason for both revisit types, associated with 33.02% of ED presentations (3.34% total surgeries) and 67.93% of readmissions (3.97% total surgeries). Day 5 post-surgery was the median revisit time for both ED presentations (IQR 3-7) and readmission (IQR 3-8). Predictors of revisit included older age, public and metropolitan hospitals and peri-operative complications during surgery.
Haemorrhage was the most common reason for both emergency department presentation and hospital readmission. The higher risk of revisits associated with older children, surgeries performed in public and metropolitan hospitals, and in patients experiencing peri-operative complications, suggest the need for improved education of postoperative care for caregivers, and avoidance of inappropriate early discharge.
扁桃体切除术（包括或不包括腺样体切除术）是导致儿科非计划性住院再入院的主要原因，其中一些是可以避免的。减少非计划性住院再入院可提高患者安全性并减少医疗资源的使用。本研究旨在描述在澳大利亚维多利亚州进行的一项大型 statewide队列研究中，儿童扁桃体切除术和腺样体切除术患者术后 30 天内因任何与手术相关的医院再次就诊（包括急诊就诊和再次入院）的发生率、时间和危险因素。
我们使用行政数据集进行了一项基于人群的队列研究，该数据集涵盖了 2010 年至 2015 年间在澳大利亚维多利亚州进行的所有扁桃体切除术和腺样体切除术手术。主要结局是术后 30 天内到急诊科就诊或医院再次入院。
2010 年至 2015 年间，有 46583 名患者接受了 47054 次手术。共有 4758 次急诊就诊（总手术的 10.11%）和 2750 次再次入院（总手术的 5.84%）。出血是两种就诊类型的最常见原因，与 33.02%的急诊就诊（总手术的 3.34%）和 67.93%的再次入院（总手术的 3.97%）相关。急诊就诊和再次入院的中位数就诊时间均为术后第 5 天（IQR 3-7）。再次就诊的预测因素包括年龄较大、在公立医院和大都市医院就诊以及手术期间发生围手术期并发症。
出血是急诊就诊和医院再次入院的最常见原因。年龄较大的儿童、在公立医院和大都市医院接受手术以及围手术期并发症患者再次就诊的风险较高，这表明需要加强对照顾者术后护理的教育，并避免不适当的提前出院。
