title: Risk of reoperation after tonsillotomy versus tonsillectomy: a population-based cohort study.
abstract: Tonsil surgery to address upper airway obstruction in children can be performed either as a tonsillectomy (TE) or as a tonsillotomy/intracapsular/partial tonsillectomy (TT). The advantage of TT is a decreased risk of postoperative morbidity. The disadvantage is the risk of tonsil regrowth with recurrence of symptoms and/or problems with future tonsil infections, which may demand a reoperation of the tonsils. The aim of this study is to compare the risk of reoperation of the tonsils following TE and TT in children with tonsil-related upper airway obstruction. This is a retrospective register-based cohort study of the Swedish National Patient Register. All children aged 1-12 years who underwent TE or TT from 2007 to 2012 for the main indication of upper airway obstruction were included in the study. The unique Personal Identity numbers were used to follow patients over time in the register and identify additional tonsil surgery. A total of 27,535 patients were included in the study, contributing 76,054 person-years of follow-up. A total of 684 patients (2.5 %) underwent a second tonsil surgery during follow-up. The incidences of reoperation were 1.94 per 1000 person-years in the TE group and 16.34 per 1000 person-years in the TT group. The risk for reoperation was seven times higher (HR 7.16) after TT compared to TE. Younger age was significantly associated with reoperation for both TE and TT and the difference in risk between TE and TT gradually decreased with time. The most common indication for reoperation after both TE and TT was "Upper airway obstruction".
authors.affiliation: Department of Otorhinolaryngology, Sahlgrenska University Hospital, Gröna stråket 5, 413 45, Gothenburg, Sweden. erik.odhagen@vgregion.se.|Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden. erik.odhagen@vgregion.se.
authors.forename: Erik
authors.initials: E
authors.lastname: Odhagen
authors.affiliation: Department of Otorhinolaryngology, Ryhov County Hospital, Jönköping, Sweden.|Futurum-The Academy for Health and Care, County Council, Jönköping, Sweden.
authors.forename: Ola
authors.initials: O
authors.lastname: Sunnergren
authors.affiliation: Sollentuna Specialist Clinic, Stockholm, Sweden.
authors.forename: Claes
authors.initials: C
authors.lastname: Hemlin
authors.affiliation: Department of Otorhinolaryngology, Aleris Sabbatsberg, Stockholm, Sweden.|Division of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Anne-Charlotte
authors.initials: AC
authors.lastname: Hessén Söderman
authors.affiliation: Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Ericsson
authors.affiliation: Department of Otorhinolaryngology, Sahlgrenska University Hospital, Gröna stråket 5, 413 45, Gothenburg, Sweden.|Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
authors.forename: Joacim
authors.initials: J
authors.lastname: Stalfors
mesh_terms: D000293:Adolescent; D000402:Airway Obstruction / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D014066:Palatine Tonsil / Q000254:growth & development / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D013548:Sweden; D014068:Tonsillectomy / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data
keywords: Regrowth; Reoperation; Tonsil surgery; Tonsillectomy; Tonsillotomy