Pan‐Scotland tonsillectomy outcomes: A national cross‐sectional study

Milner, Thomas D.; Hilmi, Omar; Marshall, John; MacKenzie, Kenneth

doi:10.1111/coa.13608

Cited by 9 publications

(13 citation statements)

References 20 publications

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“…Another explanation for Australia’s PTH rates for adults may be a potential change in the risk-profile of PTH in patients over time. This may occur as a result of clinicians becoming more stringent with the indication criteria for tonsillectomy, as suggested by Milner et al as a conceivable reason for an increase in national rates of PTH over time as observed in Scotland [ 23 ]. The joint position paper released in July 2008 by the Royal Australasian College of Physicians and The Australian Society of Otolaryngology Head and Neck Surgery provided a national guideline on the indications for tonsillectomy and adenotonsillectomy [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

“…PTH rates that are widely considered as benchmarks rates had been derived either from national database studies [14][15][16][19][20][21][22][23][24], large prospective cohort studies [25,26] or national surgery quality registers, conducted in various countries [27,28]. For comparative purposes, only studies that have reported PTH rates defined by severe haemorrhage episodes that required the return to theatre are listed in Table 4.…”

Section: Reference Pth Ratesmentioning

confidence: 99%

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Reference rate for post-tonsillectomy haemorrhage in Australia—A 2000–2020 national hospital morbidity database analysis

Forer

Veivers

2022

PLoS ONE

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This study aims to provide a national benchmark rate of post-tonsillectomy haemorrhage (PTH) in Australia. Using data from Australia’s National Hospital Morbidity Database (NHMD) from 1 July 2000 to 30 June 2020, we have conducted a nation-wide population-based study to estimate a reference rate of PTH. Outcomes of interest included the overall rate and time-trend of PTH, the relationship between PTH rates with age and gender as well as the epidemiology of tonsillectomy procedures. A total of 941,557 tonsillectomy procedures and 15,391 PTH episodes were recorded for the study period. Whilst the incidence of tonsillectomy procedures and the number of day-stay tonsillectomy procedures have increased substantially over time, the overall rate of PTH for all ages has remained relatively constant (1.6% [95% CI: 1.61 to 1.66]) with no significant association observed between the annual rates of PTH and time (year) (Spearman correlation coefficient, Rs = 0.24 (95% CI: -0.22 to 0.61), P = 0.3). However, the rate of PTH in adults (aged 15 years and over) experienced a statistically significant mild to moderate upward association with time (year) Rs = 0.64 (95% CI: 0.28 to 0.84), P = 0.003. Analysis of the odds of PTH using the risk factors of increasing age and male gender showed a unique age and gender risk pattern for PTH where males aged 20 to 24 years had the highest risk of PTH odds ratio 7.3 (95% CI: 6.7 to 7.8) compared to patients aged 1 to 4 years. Clinicians should be mindful of the greater risk of PTH in male adolescents and young adults. The NHMD datasets can be continually used to evaluate the benchmark PTH rate in Australia and to facilitate tonsillectomy surgical audit activities and quality improvement programs on a national basis.

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Section: Discussionmentioning

confidence: 99%

Section: Reference Pth Ratesmentioning

confidence: 99%

Reference rate for post-tonsillectomy haemorrhage in Australia—A 2000–2020 national hospital morbidity database analysis

Forer

Veivers

2022

PLoS ONE

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“…As such, there is a wide reported rate ranging from 2% to19%. [7][8][9][10][11][12] An accurate insight into the true incidence of PTH and possible risk factors is of paramount importance to accurately counsel patients preoperatively and because of the associated chance of readmission, reoperation, or most significantly, mortality. 13 This study demonstrates a higher rate of postoperative hemorrhage among adults than is typically reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

Investigation of Adult Post‐Tonsillectomy Hemorrhage Rates and the Impact of NSAID Use

et al. 2021

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Objectives/Hypothesis Tonsillectomy is one of the most common ambulatory surgeries performed in the United States, yet the incidence of post‐tonsillectomy hemorrhage (PTH) in adults remains unclear. In addition, any association between non‐steroidal anti‐inflammatory drugs (NSAIDs) and PTH in adults is currently unknown. The aim of this study is to examine the incidence and management of adult PTH at a single academic center and to assess for any association between NSAID use and PTH in adults. Study Design Retrospective chart review. Methods We conducted a retrospective chart review of adult tonsillectomies performed at our institution between January 1, 2012, and December 30, 2019. Demographics, past medical history, medications, NSAID use, surgical indication, bleeding events, and interventions were documented. The rate of PTH was calculated, logistic regression was performed to assess for any predictive factors, and odds ratios were calculated for NSAID use and PTH. Results A total of 1,057 adult tonsillectomies were performed within the aforementioned time period. A total of 126 patients experienced 163 bleeding events for a postoperative hemorrhage rate of 11.9%. Most were controlled with bedside interventions, while 29 (23%) bled more than once. The hemorrhage rate for those who were not prescribed NSAIDs postoperatively (n = 625) was 11.7%, compared to 12.6% for those who did receive NSAIDs postoperatively (n = 432), which was not significantly different (adjusted odds ratio 1.01, 95% confidence interval 0.69–1.49; P = .95). Conclusions This retrospective cohort study of 1,057 adult patients found the incidence of PTH to be 11.9%. This study found no association between the use of NSAIDs and the rate of PTH, although a higher‐powered study is needed. Level of Evidence 3 Laryngoscope, 132:949–953, 2022

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“…Whilst the National Prospective Tonsillectomy Audit in 2003/4 may have missed some patients, the methodology would seem unlikely to miss significant numbers. Milner et al 2 compared routinely data collected using the same methodologies during the two periods. Whilst coding of surgery may be inaccurate, it is hard to see how the significant rise could be anything other than genuine.…”

Section: Rise In Complication Rates For Tonsillectomymentioning

confidence: 99%

“…In the second, Milner et al 2 analysed routinely collected data for adults and children, in a pan‐Scotland study to examine post‐tonsillectomy haemorrhage and return‐to‐theatre rates. A comparison was made between 1998‐2002 and 2013‐2017.…”

Section: Introductionmentioning

confidence: 99%