Tonsillectomy and the Risk for Deep Neck Infection—A Nationwide Cohort Study

Wang, Ying‐Piao; Wang, Mao-Che; Lin, Hung-Ching; Lee, Kuo‐Sheng; Chou, Pesus

doi:10.1371/journal.pone.0117535

Cited by 17 publications

(21 citation statements)

References 44 publications

(39 reference statements)

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“…tonsil, teeth, salivary gland, deep neck lymph nodes or malignancy. 10 It is therefore likely that some of the infections described here are secondary to non-tonsil infections. There is currently no literature available describing the proportion of deep neck abscesses caused by infection in the different sites; peritonsillar abscess, however, is predominantly seen in association with tonsil infection.…”

Section: Discussionmentioning

confidence: 94%

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Serious tonsil infections versus tonsillectomy rates in Wales: A 15-year analysis

Yap

Harris

Clarke

2017

annals

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INTRODUCTION Sore throat and tonsillitis place a significant burden on the National Health Service. National guideline criteria for gauging the severity of sore throat and tonsillitis have reduced the number of tonsillectomies performed, which is thought to have increased the rate of tonsil-related infections. METHODS Data was extracted from the prospective Patient Episode Database of Wales and analysed to determine the annual number of tonsillectomies for recurrent tonsillitis, adjusted for population changes. Admissions to acute hospitals for tonsillitis, peritonsillar abscess and deep neck space abscesses were also examined. RESULTS Between 1999 and 2014, hospital admissions for tonsillitis rose three-fold (r=0.968), while admissions for peritonsillar abscess rose by 48% (r=0.857) and retro or parapharyngeal abscess admissions also increased (r=0.709). In contrast, the number of tonsillectomies per 100,000 population gradually decreased (r=-0.16). There was a positive correlation between the incidence of tonsillitis and admissions for peritonsillar abscess (adjusted r 2 0.631; p=0.015) and retropharyngeal abscess (adjusted r

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Section: Discussionmentioning

confidence: 94%

“…Tonsillectomy is one of the most common surgical procedures throughout the world, especially in children. 10 The surgical rate varies considerably, from 1.9 per 1000 children in Canada to 11.8 per children in Northern Ireland in 1998.…”

Section: Discussionmentioning

confidence: 99%

Serious tonsil infections versus tonsillectomy rates in Wales: A 15-year analysis

Yap

Harris

Clarke

2017

annals

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“…Several diseases that can lead to an immunocompromised status can be DNI risk factors; these include chronic kidney disease (CKD), DM, and liver cirrhosis (LC) 1,3,4,18 . In addition, tonsillectomy is confirmed a DNI risk factor 19 . Therefore, both our cohorts were evaluated for these comorbidities.…”

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confidence: 81%

Deep Neck Infection in Systemic Lupus Erythematosus Patients: Real-World Evidence

Chang

Lin

et al. 2020

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Systemic lupus erythematosus (SLE) might increase deep neck infection (DNI) risk, but evidencesupporting this hypothesis is limited. In this retrospective follow-up study, the SLE-DNI association was investigated using data from the Registry for Catastrophic Illness Patients, which is a subset of the Taiwan National Health Insurance Research Database. All patients newly diagnosed as having SLE in 1997-2011 were identified, and every SLE patient was individually matched to four patients without SLE according to sex, age, and socioeconomic status. The study outcome was DNI occurrence. DNI treatment modalities and prognoses in SLE and non-SLE patients, along with the association of steroid dose with DNI risk, were also studied. In total, 17,426 SLE and 69,704 non-SLE patients were enrolled. Cumulative DNI incidence was significantly higher in the SLE cohort than in the non-SLE cohort (p < 0.001). The Cox regression model demonstrated that SLE significantly increased DNI risk (hazard ratio: 4.70; 95% confidence interval: 3.50-6.32, p < 0.001). Moreover, in the sensitivity and subgroup analyses, the effect of SLE on DNI was stable. Relatively few SLE-DNI patients received surgical interventions (15.6% vs. 28.6%, p = 0.033). The between-group differences in tracheostomy use and hospitalisation duration were nonsignificant. In SLE patients, high steroid doses significantly increased Dni incidence (≥3 vs. <3 mg/day = 2.21% vs. 0.52%, p < 0.001). This is the first study demonstrating that SLE increases DNI risk by approximately five times and that high steroid dose increases DNI incidence in SLe patients. The prevalent infectious disease deep neck infection (DNI) is typically encountered in emergency departments.Patients with DNI typically require intensive care and aggressive treatment. DNI has the likelihood to be life threatening, notably in systemic disease patients and elderly individuals 1-3 . Immunocompromised patients do not show usual symptoms of DNI, making its early diagnosis difficult, possibly increasing complications and mortality 1,3-5 . Therefore, investigating the influence of immunosuppressing diseases on DNI is important.Systemic lupus erythematosus (SLE) renders its affected patients vulnerable to infection; in addition, in such patients undergoing dialysis, infection is a notable cause of mortality 6-9 . SLE activity itself and long-term usage of immunosuppressants are considered the two main causes for infection susceptibility 6,10 . In their case series of 130 patients with DNI, Yang et al. 11 reported two cases of DNI in patients with SLE under steroid therapy. However, the influence of SLE on DNI was not investigated in depth. In addition, the association between the duration of SLE, steroid dosage, and DNI risk remains unknown. We therefore conducted this real-world study with the primary purpose of probing the influence exerted by SLE on DNI incidence, treatment, and prognosis.

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“…One case-control study reported that the odds ratio (OR) of a deep neck infection after tonsillectomy was 7.10 (95% confidence interval, CI = 2.52–19.93) [ 8 ]. The other cohort study reported that patients with a previous tonsillectomy have a 1.71 times greater risk of deep neck infection (95% CI = 1.13–2.59) [ 9 ]. However, in the previous studies, the “participants with tonsillectomy” group and the “participants without tonsillectomy” group were not well matched for their susceptibility to upper respiratory infection (URI).…”

Section: Introductionmentioning

confidence: 99%

Tonsillectomy increases the risk of retropharyngeal and parapharyngeal abscesses in adults, but not in children: A national cohort study

et al. 2018

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ObjectivesThe purpose of this study is to evaluate the risk of retropharyngeal and parapharyngeal abscesses (deep neck infection) after tonsillectomy in Koreans using national cohort data.MethodsUsing the national cohort study from the Korean Health Insurance Review and Assessment Service, participants who had undergone a tonsillectomy (5,299) and control participants (21,196) were selected and matched 1:4 (for age, sex, income, region of residence, and pre-operative upper respiratory infection visits). The Cox-proportional hazard model was used. A crude model and an adjusted model for age, sex, income, region of residence, hypertension, diabetes, and dyslipidemia were used in this analysis. For the subgroup analyses, the participants were divided into 2 groups: children (≤ 14 years old) and adolescents and adults (≥ 15 years old).ResultsThe adjusted hazard ratio of deep neck infection after tonsillectomy was 1.43 (95% confidence interval, CI = 1.18–1.72, P < 0.001). In subgroup analysis, this ratio was 1.12 (95% CI = 0.86–1.47, P = 0.390) in children and 1.87 (95% CI = 1.43–2.45, P < 0.001) in adolescents and adults. The crude hazard ratios were almost the same as the adjusted ratios.ConclusionThe risk of deep neck infection was higher in the tonsillectomy group. The subgroup analysis showed a similar finding in the adolescent and adult group but not in the child group.

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Tonsillectomy and the Risk for Deep Neck Infection—A Nationwide Cohort Study

Cited by 17 publications

References 44 publications

Serious tonsil infections versus tonsillectomy rates in Wales: A 15-year analysis

Serious tonsil infections versus tonsillectomy rates in Wales: A 15-year analysis

Deep Neck Infection in Systemic Lupus Erythematosus Patients: Real-World Evidence

Tonsillectomy increases the risk of retropharyngeal and parapharyngeal abscesses in adults, but not in children: A national cohort study

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