Hathi Kalpesh, Francis Gizelle, Douglas JoAnne, Nemeth Evan, Hong Paul
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada.
Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
J Otolaryngol Head Neck Surg. 2025 Jan-Dec;54:19160216251333350. doi: 10.1177/19160216251333350. Epub 2025 May 14.
ImportancePost-tonsillectomy complications often present in emergency departments (EDs). Reducing postoperative ED visits is one strategy to relieve the strain on healthcare systems and patients.ObjectiveTo assess the rate and reason for ED visits within 90-days post-discharge from adult tonsillectomy.DesignRetrospective cohort study.SettingNova Scotia, Canada.ParticipantsAll adult patients (≥16 years old) with a Nova Scotia Healthcare card who underwent a tonsillectomy in Nova Scotia, Central Zone from April 1, 2016 to March 31, 2022, and had an ED visit anywhere in Nova Scotia from April 1, 2016 to June 30, 2022, to allow a 90-days post-discharge window.MethodsRetrospective chart review utilizing administrative datasets for province-wide ED visits within 90-days post-discharge from an adult tonsillectomy. The patients' first ED visit postoperation was analyzed.ResultsOverall, 356 adult patients underwent tonsillectomy, of which 129 (36.2%) presented to the ED within 90 days. Of these, 99 were related to the tonsillectomy, resulting in a surgery-specific ED rebound rate of 27.8%. Most surgical ED visits (84/99, 84.8%) occurred within 7 days, most commonly for bleeding (47/99, 47.5%) and pain (36/99, 36.4%). Of the surgical visits, 26/99 (26.3%) were admitted, with 22/26 (84.6%) for bleeding. Of the surgical visits not related to bleeding, 48/52 (92.3%) were discharged home or left without being seen, which suggests 48/99 (48.5%) surgical ED visits may be preventable.ConclusionThe ED rebound rate for visits related to the tonsillectomy was 27.8% in our population. Given the potentially severe consequences of post-tonsillectomy bleeding, a high ED visit rate may be necessary. However, optimization of postoperative pain control along with greater access to urgent outpatient otolaryngology and primary care resources may reduce the burden of ED visits. This data adds to recent literature suggesting a higher rate of healthcare usage post-adult tonsillectomy.
重要性扁桃体切除术后并发症常在急诊科出现。减少术后急诊就诊是缓解医疗系统和患者负担的一种策略。
目的评估成人扁桃体切除术后出院90天内急诊就诊的发生率及原因。
设计回顾性队列研究。
地点加拿大新斯科舍省。
参与者所有持有新斯科舍省医疗卡且年龄≥16岁的成年患者，他们于2016年4月1日至2022年3月31日在新斯科舍省中部地区接受了扁桃体切除术，并于2016年4月1日至2022年6月30日在新斯科舍省的任何地方有过急诊就诊，以留出90天的出院后观察期。
方法利用行政数据集对成人扁桃体切除术后出院90天内全省范围的急诊就诊情况进行回顾性病历审查。对患者术后的首次急诊就诊进行分析。
结果总体而言，356例成年患者接受了扁桃体切除术，其中129例（36.2%）在90天内前往急诊科就诊。其中，99例与扁桃体切除术有关，手术特异性急诊反弹率为27.8%。大多数手术相关的急诊就诊（84/99，84.8%）发生在7天内，最常见的原因是出血（47/99，47.5%）和疼痛（36/99，36.4%）。在手术相关的就诊中，26/99（26.3%）患者住院，其中22/26（84.6%）是因为出血。在与出血无关的手术就诊中，48/52（92.3%）患者出院回家或未就诊就离开，这表明48/99（48.5%）的手术相关急诊就诊可能是可以预防的。
结论在我们的研究人群中，与扁桃体切除术相关的急诊反弹率为27.8%。鉴于扁桃体切除术后出血可能产生的严重后果，较高的急诊就诊率可能是必要的。然而，优化术后疼痛控制以及增加获得紧急门诊耳鼻喉科和初级保健资源的机会可能会减轻急诊就诊的负担。这些数据补充了近期的文献，表明成人扁桃体切除术后医疗使用频率较高。
