Tonsillectomy or tonsillotomy? A systematic review for paediatric sleep-disordered breathing

Zhang, Lai-Ying; Zhong, Laurie; David, Michael; Cervin, Anders

doi:10.1016/j.ijporl.2017.10.008

Cited by 44 publications

(53 citation statements)

References 49 publications

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“…Comparing the results of postoperative hemorrhage between trials is difficult because of the variety of definitions used. The severity of hemorrhage is frequently not reported . We used two definitions of postoperative hemorrhage, readmission due to postoperative hemorrhage and RTT due to postoperative hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

“…In a systematic review by Zhang et al (32 studies, 19 randomized and 13 nonrandomized), the odds of a secondary hemorrhage (after 24 hours) occurring were 79% less after TT than after TE (OR: 0.21 [95% CI: 0.17‐0.27], P < .01). According to the 17 studies in the review that reported events of hemorrhage requiring a return to hospital, TT had a much lower incidence than TE (0.2% vs. 1.4%) …”

Section: Discussionmentioning

confidence: 99%

“…It has been previously stated that TT, with its less‐invasive character, has advantages over TE, not only regarding postoperative hemorrhage but also when considering postoperative pain and nausea, resulting in earlier return to normal diet and activity after TT than after TE . The nature of the data included in the NPR does not allow evaluation of the severity of postoperative morbidity in other aspects except those resulting in readmission to hospital or contact with healthcare as an outpatient visit.…”

Section: Discussionmentioning

confidence: 99%

“…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 . Furthermore, TT has proven to be as effective as TE in the treatment of upper airway obstruction as measured by both self‐report of symptom relief and polysomnographic outcomes of airway obstruction during sleep .…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

2018

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“…Procedures were performed using electrocautery and/or sharp dissection—seven of 10 otolaryngologists used electrocautery as their primary technique, whereas three utilized sharp dissection. Surgeries performed via microdebrider were excluded as there are data showing less postoperative pain with this technique . Seven of 10 surgeons administered local anesthetic during the procedure according to their preference.…”

Section: Methodsmentioning

confidence: 99%

The development of an opioid sparing anesthesia protocol for pediatric ambulatory tonsillectomy and adenotonsillectomy surgery—A quality improvement project

Franz

Dahl

Huang

et al. 2019

Pediatric Anesthesia

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Pain management following pediatric tonsillectomy and adenotonsillectomy surgery is challenging and traditionally involves perioperative opioids. However, the recent national opioid shortage compelled anesthesiologists at Bellevue Surgery Center to identify an alternative perioperative analgesic regimen that minimizes opioids yet provides effective pain relief. We assembled an interdisciplinary quality improvement team to trial a series of analgesic protocols using the Plan-Do-Study-Act cycle.Initially, we replaced intraoperative morphine and acetaminophen (M/A protocol) with intraoperative dexmedetomidine and preoperative ibuprofen (D/I protocol).However, when results were not favorable, we rapidly transitioned to intraoperative ketorolac and dexmedetomidine (D/K protocol). The following measures were evaluated using statistical process control chart methodology and interpreted using Shewhart's theory of variation: maximum pain score in the postanesthesia care unit, postoperative morphine rescue rate, postanesthesia care unit length of stay, total anesthesia time, postoperative nausea and vomiting rescue rate, and reoperation rate within 30 days of surgery. There were 333 patients in the M/A protocol, 211 patients in the D/I protocol, and 196 patients in the D/K protocol. With the D/I protocol, there were small increases in maximum pain score and postanesthesia care unit length of stay, but no difference in morphine rescue rate or total anesthesia time compared to the M/A protocol. With the D/K protocol, postoperative pain control and postanesthesia care unit length of stay were similar compared to the M/A protocol. Both the D/I and D/K protocols had reduced nausea and vomiting rescue rates. Reoperation rates were similar between groups. In summary, we identified an intraoperative anesthesia protocol for pediatric tonsillectomy and adenotonsillectomy surgery utilizing dexmedetomidine and ketorolac that provides effective analgesia without increasing recovery times or reoperation rates. K E Y W O R D S analgesics, anesthesia, dexmedetomidine, ketorolac, quality improvement, tonsillectomy | 683 FRANZ et Al.

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Estimated Probability Distribution of Bleeding After Pediatric Tonsillectomy

Johnson

Beams

Zaniletti

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportanceThe American Academy of Otolaryngology–Head and Neck Surgery Foundation has recommended yearly surgeon self-monitoring of posttonsillectomy bleeding rates. However, the predicted distribution of rates to guide this monitoring remain unexplored.ObjectiveTo use a national cohort of children to estimate the probability of bleeding after pediatric tonsillectomy to guide surgeons in self-monitoring of this event.Design, Settings, and ParticipantsThis retrospective cohort study used data from the Pediatric Health Information System for all pediatric (&lt;18 years old) patients who underwent tonsillectomy with or without adenoidectomy in a children’s hospital in the US from January 1, 2016, through August 31, 2021, and were discharged home. Predicted probabilities of return visits for bleeding within 30 days were calculated to estimate quantiles for bleeding rates. A secondary analysis included logistic regression of bleeding risk by demographic characteristics and associated conditions. Data analyses were conducted from August 7, 2022 to January 28, 2023.Main Outcomes and MeasuresRevisits to the emergency department or hospital (inpatient/observation) for bleeding (primary/secondary diagnosis) within 30 days after index discharge after tonsillectomy.ResultsOf the 96 415 children (mean [SD] age, 5.3 [3.9] years; 41 284 [42.8%] female; 46 954 [48.7%] non-Hispanic White individuals) who had undergone tonsillectomy, 2100 (2.18%) returned to the emergency department or hospital with postoperative bleeding. The predicted 5th, 50th, and 95th quantiles for bleeding were 1.17%, 1.97%, and 4.75%, respectively. Variables associated with bleeding after tonsillectomy were Hispanic ethnicity (OR, 1.19; 99% CI, 1.01-1.40), very high residential Opportunity Index (OR, 1.28; 99% CI, 1.05-1.56), gastrointestinal disease (OR, 1.33; 99% CI, 1.01-1.77), obstructive sleep apnea (OR, 0.85; 99% CI, 0.75-0.96), obesity (OR,1.24; 99% CI, 1.04-1.48), and being more than 12 years old (OR, 2.48; 99% CI, 2.12-2.91). The adjusted 99th percentile for bleeding after tonsillectomy was approximately 6.39%.Conclusions and RelevanceThis retrospective national cohort study predicted 50th and 95th percentiles for posttonsillectomy bleeding of 1.97% and 4.75%. This probability model may be a useful tool for future quality initiatives and surgeons who are self-monitoring bleeding rates after pediatric tonsillectomy.

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Tonsillectomy or tonsillotomy? A systematic review for paediatric sleep-disordered breathing

Cited by 44 publications

References 49 publications

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

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

The development of an opioid sparing anesthesia protocol for pediatric ambulatory tonsillectomy and adenotonsillectomy surgery—A quality improvement project

Estimated Probability Distribution of Bleeding After Pediatric Tonsillectomy

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