L’amygdalectomie pédiatrique est une procédure consommatrice de ressources : une étude des données administratives canadiennes

Murto, Kimmo; Katz, Sherri; McIsaac, Daniel I.; Bromwich, Matthew; Vaillancourt, Régis; Walraven, Carl van

doi:10.1007/s12630-017-0888-y

Cited by 23 publications

(40 citation statements)

References 39 publications

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“…2,6 Complications of tonsillectomy are more common than with other common childhood surgical procedures: 2.7% of children are readmitted within 30 days, and 12.4% present to emergency departments, often as a result of haemorrhage. 7 Deaths occur occasionally. 8 Tonsillectomy may have long-term effects on the frequency of respiratory, infectious, and allergic conditions.…”

Section: Introductionmentioning

confidence: 99%

Incidence of indications for tonsillectomy and frequency of evidence-based surgery: a 12-year retrospective cohort study of primary care electronic records

et al. 2018

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BackgroundNeither the incidence of indications for childhood tonsillectomy nor the proportion of tonsillectomies that are evidence-based is known.AimTo determine the incidence of indications for tonsillectomy in UK children, and the proportion of tonsillectomies meeting evidence-based criteria.Design and settingA retrospective cohort study of electronic medical records of children aged 0–15 years registered with 739 UK general practices contributing to a research database.MethodChildren with recorded indications for tonsillectomy were identified from electronic medical records. Evidence-based indications included documented sore throats of sufficient frequency and severity (Paradise criteria); periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis syndrome (PFAPA); or tonsillar tumour. Other indications were considered non-evidence-based. The numbers of children subsequently undergoing tonsillectomy was then identified. The numbers with evidence-based and non-evidence-based indications for surgery among children who had undergone tonsillectomy were determined.ResultsThe authors included 1 630 807 children followed up for 7 200 159 person–years between 2005 and 2016. Incidence of evidence-based indications for tonsillectomy was 4.2 per 1000 person years; 13.6% (2144/15 760) underwent tonsillectomy. Incidence of childhood tonsillectomy was 2.5 per 1000 person years; 11.7% (2144/18 281) had evidence-based indications, almost all with Paradise criteria. The proportion of evidence-based tonsillectomies was unchanged over 12 years. Most childhood tonsillectomies followed non-evidence-based indications: five to six sore throats (12.4%) in 1 year, two to four sore throats (44.6%) in 1 year, sleep disordered breathing (12.3%), or obstructive sleep apnoea (3.9%).ConclusionIn the UK, few children with evidence-based indications undergo tonsillectomy and seven in eight of those who do (32 500 of 37 000 annually) are unlikely to benefit.

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Section: Introductionmentioning

confidence: 99%

Incidence of indications for tonsillectomy and frequency of evidence-based surgery: a 12-year retrospective cohort study of primary care electronic records

et al. 2018

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“…Indeed, AT patients were sixth in order of having this reason for readmission. 1 In the AT group, pain was nine times more often the cause for readmission than breathing problems. Does this mean that there is greater caution in analgesic use and consequently poorer pain control in this population or that SDB is underdiagnosed in the non-AT population?…”

mentioning

confidence: 93%

“…In this issue of the Journal, Murto et al 1 describe analysis of a large surgical population of children up to age 18 yr (excluding newborns) in Ontario from [2002][2003][2004][2005][2006][2007][2008][2009][2010][2011][2012][2013]. The primary focus is on adenotonsillectomy (AT), comprising almost one-third of surgeries, although data for the ten commonest childhood surgical procedures are also presented.…”

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confidence: 96%

“…A Charlson comorbidity score of 3 increased the risk of urgent readmissions more than threefold. 1 Judging from these findings, there is a need for a more proactive approach to prevent such postoperative complications.…”

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confidence: 99%

“…En fait, les patients ayant subi une adéno-amygdalectomie étaient en sixième position parmi les patients réadmis pour cette raison. 1 Dans le groupe adéno-amygdalectomie, la douleur était neuf fois plus fréquemment la cause de réadmission que les problèmes respiratoires. Faut-il comprendre qu'une prudence plus grande est employée dans l'utilisation d'analgésiques, et donc que le contrôle de la douleur est moins bon, dans cette population?…”

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Expanding the circle of care: Can children find a perioperative surgical home?

Withington

2017

Can J Anesth/J Can Anesth

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Association of Patient Characteristics With Postoperative Mortality in Children Undergoing Tonsillectomy in 5 US States

Edmonson

Zhao

Francis

et al. 2022

JAMA

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IMPORTANCEThe rate of postoperative death in children undergoing tonsillectomy is uncertain. Mortality rates are not separately available for children at increased risk of complications, including young children (aged <3 y) and those with sleep-disordered breathing or complex chronic conditions. OBJECTIVE To estimate postoperative mortality following tonsillectomy in US children, both overall and in relation to recognized risk factors for complications. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study based on longitudinal analysis of linked records in state ambulatory surgery, inpatient, and emergency department discharge data sets distributed by the Healthcare Cost and Utilization Project for 5 states covering 2005 to 2017. Participants included 504 262 persons younger than 21 years for whom discharge records were available to link outpatient or inpatient tonsillectomy with at least 90 days of follow-up.EXPOSURES Tonsillectomy with or without adenoidectomy. MAIN OUTCOME AND MEASURESPostoperative death within 30 days or during a surgical stay lasting more than 30 days. Modified Poisson regression with sample weighting was used to estimate postoperative mortality per 100 000 operations, both overall and in relation to age group, sleep-disordered breathing, and complex chronic conditions. RESULTSThe 504 262 children in the cohort underwent a total of 505 182 tonsillectomies (median [IQR] patient age, 7 [4-12] years; 50.6% females), of which 10.1% were performed in young children, 28.9% in those with sleep-disordered breathing, and 2.8% in those with complex chronic conditions. There were 36 linked postoperative deaths, which occurred a median (IQR) of 4.5 (2-20.5) days after surgical admission, and most of which (19/36 [53%]) occurred after surgical discharge. The unadjusted mortality rate was 7.04 (95% CI, 4.97-9.98) deaths per 100 000 operations. In multivariable models, neither age younger than 3 years nor sleep-disordered breathing was significantly associated with mortality, but children with complex chronic conditions had significantly higher mortality (16 deaths/14 299 operations) than children without these conditions (20 deaths/490 883 operations) (117.22 vs 3.87 deaths per 100 000 operations; adjusted rate difference, 113.55 [95% CI,] deaths per 100 000 operations; adjusted rate ratio, 29.39 [95% CI,). Children with complex chronic conditions accounted for 2.8% of tonsillectomies but 44% of postoperative deaths. Most deaths associated with complex chronic conditions occurred in children with neurologic/neuromuscular or congenital/genetic disorders.CONCLUSIONS AND RELEVANCE Among children undergoing tonsillectomy, the rate of postoperative death was 7 per 100 000 operations overall and 117 per 100 000 operations among children with complex chronic conditions. These findings may inform decision-making for pediatric tonsillectomy.

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L’amygdalectomie pédiatrique est une procédure consommatrice de ressources : une étude des données administratives canadiennes

Abstract: Post-discharge readmissions and ED visits are relatively common after pediatric surgery, particularly for AT. Perioperative treatment algorithms that consider risk factors for hospital revisits are required in children.

Cited by 23 publications

References 39 publications

Incidence of indications for tonsillectomy and frequency of evidence-based surgery: a 12-year retrospective cohort study of primary care electronic records

Incidence of indications for tonsillectomy and frequency of evidence-based surgery: a 12-year retrospective cohort study of primary care electronic records

Expanding the circle of care: Can children find a perioperative surgical home?

Association of Patient Characteristics With Postoperative Mortality in Children Undergoing Tonsillectomy in 5 US States

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