title: Factors influencing morbidity after paediatric tonsillectomy: a study of 18,712 patients in the National Tonsil Surgery Register in Sweden.
abstract: The objective of this study was to examine factors affecting morbidity after tonsillectomy in children. Data from the National Tonsil Surgery Register in Sweden on 18,712 patients who underwent tonsillectomy with or without simultaneous adenoidectomy between 1 and 18 years of age were analysed. This register includes data on sex, gender, surgical indication, and the surgical and haemostasis techniques used for each patient, as well as patient-reported outcomes for haemorrhage, analgesic use and antibiotic use. Comparison of patients who underwent surgery for infection versus upper airway obstruction revealed a significant increase in haemorrhage complications in the infection group. However, no significant difference remained after the adjustments for confounders in multivariable regression analysis. Instead, the increased risk among patients who underwent surgery for infection was mainly attributable to the use of bipolar diathermy and increased patient age. Patients who received surgery for infection reported more days of analgesic use, as well as more unplanned contacts with a health care service provider due to pain, compared with those who underwent surgery for upper airway obstruction. These results remained significant in multivariate analysis. The use of bipolar diathermy for haemostasis resulted in an increased risk, while the use of cold steel surgical instruments, a younger patient age and female sex led to a decreased risk. The surgical and haemostasis techniques used are the most important factors that affect morbidity after tonsillectomy in the paediatric age group. The choice of surgical techniques is of utmost importance for decreasing morbidity in these patients.
authors.affiliation: Department of Otorhinolaryngology, Västerås Central Hospital, Västerås, Sweden.
authors.forename: Karolina
authors.initials: K
authors.lastname: Elinder
authors.affiliation: Division of Clinical Science, Intervention and Technology, Department of Otorhinolaryngology Aleris Sabbatsberg, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Anne-Charlotte Hessén
authors.initials: AC
authors.lastname: Söderman
authors.affiliation: Department of Otorhinolaryngology, Sahlgrenska University Hospital, and Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden. joacim@stalfors.se.
authors.forename: Joacim
authors.initials: J
authors.lastname: Stalfors
authors.affiliation: Department of Otorhinolaryngology, Västerås Central Hospital, Västerås, Sweden.|Centre for Clinical Research, Uppsala University, County Hospital, Västerås, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Knutsson
mesh_terms: D000293:Adolescent; D000700:Analgesics / Q000627:therapeutic use; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods; D006489:Hemostatic Techniques; D006801:Humans; D007223:Infant; D016014:Linear Models; D008297:Male; D009017:Morbidity; D015508:Nasal Obstruction / Q000601:surgery*; D010146:Pain / Q000209:etiology; D010149:Postoperative Pain / Q000628:therapy; D014066:Palatine Tonsil; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000601:surgery; D012042:Registries; D011795:Surveys and Questionnaires; D013548:Sweden; D014068:Tonsillectomy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D014069:Tonsillitis / Q000601:surgery
chemical_list: D000700:Analgesics; D000900:Anti-Bacterial Agents
keywords: Child; Morbidity; Post-operative pain; Post-tonsillectomy haemorrhage; Tonsillar hypertrophy; Tonsillectomy; Tonsillitis