The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
J Paediatr Child Health. 2022 Sep;58(9):1608-1615. doi: 10.1111/jpc.16052. Epub 2022 Jun 3.
To investigate the impact of adenotonsillectomy (ADT) and adenoidectomy (AD) on child health and evaluated their post-operative complications.
We included all children aged <16 years undergoing ADT (tonsillectomy ± adenoidectomy) or AD in New South Wales, Australia, 2008-2017. Health information was obtained from administrative hospitalisation data. Rates of post-operative complications and reoperation were evaluated using generalised estimating equations and Kaplan-Meier methods, respectively.
Out of 156 500 included children, 112 361 had ADT and 44 139 had AD. Population rates increased during 2008-2017 (ADT: 68-79 per 10 000 children; AD: 25-34 per 10 000), and children were increasingly operated on at a younger age. Overall, 7262 (6.5%) and 1276 (2.9%) children had post-operative complications (mostly haemorrhage), and 4320 (3.8%) and 5394 (12.2%) required reoperation, following ADT and AD, respectively. Complication rates were highest among children aged 0-1 years, lowest for those 2-5 years and increased with age thereafter. Three-year reoperation rates for children aged 0-1 years were 9.0% and 25.9% following ADT and AD, respectively, decreasing thereafter to 0.5% and 2.1% in children aged 12-13 years.
ADT and AD in Australian children have both increased in frequency and are being done at a younger age. Post-operative complications and reoperation rates highlight surgery is not without risk, especially for children under 2 years old. These findings support a more conservative approach to management of upper respiratory symptoms, with surgery reserved for cases where potential benefits are most likely to outweigh harms.
探讨腺样体扁桃体切除术（ADT）和腺样体切除术（AD）对儿童健康的影响，并评估其术后并发症。
我们纳入了 2008 年至 2017 年在澳大利亚新南威尔士州接受 ADT（扁桃体切除术±腺样体切除术）或 AD 的所有<16 岁的儿童。健康信息来自于住院管理数据。采用广义估计方程和 Kaplan-Meier 方法分别评估术后并发症和再次手术的发生率。
在纳入的 156500 名儿童中，112361 名儿童接受 ADT，44139 名儿童接受 AD。2008 年至 2017 年期间，人群发病率呈上升趋势（ADT：每 10000 名儿童 68-79 例；AD：每 10000 名儿童 25-34 例），且儿童的手术年龄呈下降趋势。总体而言，ADT 和 AD 术后分别有 7262（6.5%）和 1276（2.9%）名儿童发生术后并发症（主要为出血），4320（3.8%）和 5394（12.2%）名儿童分别需要再次手术。ADT 和 AD 术后并发症发生率在 0-1 岁儿童中最高，2-5 岁儿童中最低，此后随年龄增加而升高。0-1 岁儿童 3 年的再次手术率分别为 ADT 和 AD 术后的 9.0%和 25.9%，此后在 12-13 岁儿童中降至 0.5%和 2.1%。
澳大利亚儿童的 ADT 和 AD 手术的频率均有所增加，且手术年龄呈下降趋势。术后并发症和再次手术的发生率表明手术并非没有风险，尤其是对于<2 岁的儿童。这些发现支持对上呼吸道症状采取更为保守的治疗方法，将手术保留用于潜在获益最有可能超过危害的病例。
