Trends and changes in paediatric tonsil surgery in Sweden 1987–2013: a population-based cohort study

Borgström, Anna; Nerfeldt, Pia; Friberg, Danielle; Sunnergren, Ola; Stalfors, Joacim

doi:10.1136/bmjopen-2016-013346

Cited by 48 publications

(40 citation statements)

References 31 publications

(25 reference statements)

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“…The incidence of infectious indications remained relatively stable. Similar findings have been published in other studies [18][19][20], reflecting an increased awareness of upper airway obstruction. TT is mostly performed because of obstructive symptoms, although a few studies have shown that TT can be beneficial also for children and young adults with recurrent tonsillitis [21,22].…”

Section: Discussionsupporting

confidence: 91%

“…During the period from 2007 to 2016 approximately 500 tonsil surgeries were performed every year for children at our department. The incidence of tonsil surgeries remained relatively stable, in contrast to Sweden, where the rate of tonsil surgery has doubled over 26 years in children and adolescents [18]. A potential explanation for this difference is that tonsil surgeries in the Helsinki area are performed partly by the private sector, and hence, the exact number of tonsil surgeries is not known.…”

Section: Discussionmentioning

confidence: 95%

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Changing trends in pediatric tonsil surgery

Sakki

Mäkinen

Roine

et al. 2019

International Journal of Pediatric Otorhinolaryngology

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A B S T R A C TObjectives: We analyzed trends in tonsil surgery over a 10-year period in a single tertiary care hospital and evaluated the effects of these changes on use of hospital services and healthcare costs. Methods: This was a retrospective cohort study based on data from databases at the Department of Otorhinolaryngology, Helsinki University Hospital, Helsinki, Finland. Children under 16 years of age with tonsillectomy (TE) or tonsillotomy (TT) performed during 2007-2016 were included in the study. Results: In 10 years, 4979 tonsil surgeries were performed on 4951 children: TE in 3170 (64%) and TT in 1781 (36%) children. The total number of tonsil surgeries stayed nearly constant. TT operations commenced in the study hospital in 2009 and from 2012 onwards have been more common than TE procedures. Altogether 279 patients visited the emergency department because of complications; TE patients had 9.0 visits/100 surgeries and TT patients 1.8 visits/100 surgeries. The most common complication was postoperative hemorrhage: 200 cases (6.3%) in the TE group and 11 cases (0.6%) in the TT group. During the two-year follow-up after tonsil surgery the total costs of healthcare services were significantly lower in the TT group than in the TE group. Conclusion: Considerable changes have occurred in tonsil surgery in children during the 10-year study period; TT is today performed more often than TE. As a consequence, complications, readmissions to hospital, and number of patients treated in the operating room because of postoperative hemorrhage have decreased, lowering the costs of healthcare.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 95%

Changing trends in pediatric tonsil surgery

Sakki

Mäkinen

Roine

et al. 2019

International Journal of Pediatric Otorhinolaryngology

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“…Surgery performed on this immune defence system remains the most common surgical procedure in children, with the highest rate of interventions between 3 and 5 years of age. Surgical indications for this procedure have varied over the years, although they focus on the prevention of recurrent infections and the treatment of OSAS.…”

Section: Introductionmentioning

confidence: 99%

“…4 In addition, in both adults and paediatric populations there is clear evidence of the association between obstructive sleep apnoea-hypopnea syndrome (OSAS) linked to tonsillar hypertrophy and systemic inflammatory phenomena, as well as an increased risk of cardiovascular disease in adulthood. 5,6 Surgery performed on this immune defence system remains the most common surgical procedure in children, [7][8][9] with the highest rate of interventions between 3 and 5 years of age. Surgical indications for this procedure have varied over the years, although they focus on the prevention of recurrent infections and the treatment of OSAS.…”

mentioning

confidence: 99%

Impact of adenotonsillectomy on the evolution of inflammatory markers

Marcano-Acuña

Carrasco-Llatas

Tortajada‐Girbés

et al. 2019

Clinical Otolaryngology

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Background Tonsils are first‐line host defence organs against pathogenic agents and participate in local and systemic immunity. Persistent increases in systemic inflammatory responses may contribute to associated morbidity. The aim of this study was to verify the short‐ and long‐term impact of adenotonsillectomy on the evolution of inflammatory markers in 3‐ to 9‐year‐old children. Methods A prospective and longitudinal study was conducted over 1 year in 29 children who underwent tonsillectomy due to either chronic tonsillitis or adenotonsillar hypertrophy. Measurements of high‐sensitivity C‐reactive protein (hs‐CRP) levels were taken. Levels of Th1‐type cytokines [interleukin‐1, interferon‐γ, and tumor necrosis factor‐Î± (TNF‐α)] and anti‐inflammatory Th2‐type cytokines [interleukin‐4, ‐5, ‐6, ‐10 and ‐13] were measured. Levels of transforming growth factor‐beta (TGF‐β) and intercellular adhesion molecule‐1 (ICAM‐1) were also determined. The results were compared to those of 29 control children. Results At baseline, children with surgery indications presented with higher levels of hs‐CRP, interleukin‐1 and ‐10, interferon‐γ, TNF‐α and ICAM‐1, whereas values of interleukin‐4 were significantly lower than in control children. Children with severe tonsillar obstruction had higher values of interleukin‐1, ‐4, and ‐5 and lower values of interleukin‐10 compared with children with recurrent tonsillitis. One year after surgery, the levels except IL‐4 did not show a significant difference from those obtained in the control group. The levels of hs‐CRP and TNF‐α decreased significantly in the first month. Conclusion Children with chronic tonsillitis and/or adenotonsillar hypertrophy have significantly elevated levels of proinflammatory cytokines. Adenotonsillectomy restores the normal values of these parameters 1 year after surgery.

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“…TE is an effective treatment for SDB, as shown in a number of studies, but it has the disadvantages of postoperative morbidity including pain, hemorrhage, and infection . Therefore, partial or subtotal removal of the tonsils, tonsillotomy (TT), has gained popularity in recent decades . In several studies, compared with TE, TT has been shown to be associated with a lower risk of postoperative morbidity including postoperative pain and hemorrhage .…”

Section: Introductionmentioning

confidence: 99%

Morbidity after pediatric tonsillotomy versus tonsillectomy: A population‐based cohort study

2018

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Objectives/Hypothesis: To compare and evaluate morbidity following pediatric tonsillectomy (TE) and tonsillotomy (TT) performed due to tonsil-related upper airway obstruction.Study Design: Retrospective population-based cohort study based on data from the Swedish National Patient Register (NPR).Methods: All patients aged 1 to 12 years who were registered in the NPR between January 1, 2007 and December 31, 2015, and who underwent an isolated tonsil surgery (AE adenoidectomy) for the sole indication of upper airway obstruction were included. Postoperative morbidity within 30 days of surgery, including readmission due to hemorrhage and return to theater (RTT), was evaluated and compared between the two groups. A forward stepwise multivariable logistic regression analysis was used to identify independent predictors of postoperative morbidity.Results: In total, 35,060 patients were included in the study, 23,447 of whom underwent TT and 11,613 of whom underwent TE. Readmission due to postoperative hemorrhage, RTT, readmission due to any reason, and contact with healthcare were all less common after TT than after TE. Readmission due to postoperative hemorrhage was significantly more common after TE (2.5%) than after TT (0.6%) (odds ratio: 3.91, 95% confidence interval: 3.20-4.77).Conclusions: This study showed that TT is associated with a statistically significantly lower risk of postoperative complications than TE when performed in children to correct tonsil-related upper airway obstruction. Statistically significant differences were found for all outcome variables, namely, readmission to hospital due to bleeding, RTT, readmission due to any reason, and postoperative contact with healthcare for any reason.

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Trends and changes in paediatric tonsil surgery in Sweden 1987–2013: a population-based cohort study

Cited by 48 publications

References 31 publications

Changing trends in pediatric tonsil surgery

Changing trends in pediatric tonsil surgery

Impact of adenotonsillectomy on the evolution of inflammatory markers

Morbidity after pediatric tonsillotomy versus tonsillectomy: A population‐based cohort study

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