Systematic review of tonsil surgery quality registers and introduction of the Nordic Tonsil Surgery Register Collaboration.

PURPOSE: Surgical quality registers provide tools to measure and improve the outcome of surgery. International register collaboration creates an opportunity to assess and critically evaluate national practices, and increases the size of available datasets. Even though millions of yearly tonsillectomies and tonsillotomies are performed worldwide, clinical practices are variable and inconsistency of evidence regarding the best clinical practice exists. The need for quality improvement actions is evident. We aimed to systematically investigate the existing tonsil surgery quality registers found in the literature, and to provide a thorough presentation of the planned Nordic Tonsil Surgery Register Collaboration. METHODS: A systematic literature search of MEDLINE and EMBASE databases (from January 1990 to December 2016) was conducted to identify registers, databases, quality improvement programs or comprehensive audit programs addressing tonsil surgery. RESULTS: We identified two active registers and three completed audit programs focusing on tonsil surgery quality registration. Recorded variables were fairly similar, but considerable variation in coverage, number of operations included and length of time period for inclusion was discovered. CONCLUSION: Considering tonsillectomies and tonsillotomies being among the most commonly performed surgical procedures in otorhinolaryngology, it is surprising that only two active registers could be identified. We present a Nordic Tonsil Surgery Register Collaboration-an international tonsil surgery quality register project aiming to provide accurate benchmarks and enhance the quality of tonsil surgery in Denmark, Finland, Norway and Sweden.

Mortality after tonsil surgery, a population study, covering eight years and 82,527 operations in Sweden.

The objective of this retrospective cohort study was to evaluate mortality rate and cause of death after tonsil surgery in Sweden. Two national registries were used, both run by The Swedish National Board of Health and Welfare, an agency of the Ministry of Health and Social Affairs. In the National Patient register all tonsil surgeries performed in Sweden from 2004 through 2011 were identified. The result from this search was matched with the National Cause of Death Register to identify all deaths that occurred within 30 days of tonsil surgery. Personal identity numbers were used to do the matching of registers. Details on the cause of death were obtained from the Swedish National Board of Health and Welfare. Two deaths were identified in 82,527 operations. Both patients were male, otherwise healthy, children under the age of five, operated due to tonsil-related upper airway obstruction/snoring with coblation technique. Cause of death was bleeding-related airway obstruction in both cases and hemodynamic failure caused by blood loss. Both deaths occurred after discharge from the hospital within the first postoperative week. No abnormal levels of analgesics were found in the postmortal investigations. Two deaths related to tonsil surgery (performed on benign indications) were identified in 82,527 operations (2004-2011) in a well-defined national population. Both deaths were due to postoperative bleeding. Based on our findings, the frequency of post-tonsil-surgery mortality in Sweden was 1/41,263, 2004-2011. Level of evidence 2b retrospective cohort study.

Practice, complications and outcome in Swedish tonsil surgery 2009-2018. An observational longitudinal national cohort study.

Background: To assure a high quality in tonsil surgery, it is necessary to monitor trends in clinical practice, complications and outcome.Aims/objectives: To describe rates and trends regarding indications, methods, techniques, complications, and outcome of tonsil surgery.Material and method: 98 979 surgeries from the National Tonsil Surgery Register 2009-2018. Groups were categorised by indication and method.Results: The proportion of patients undergoing tonsillotomy with adenoidectomy due to obstruction-snoring (mean age 5.3 y.) increased from 2009-2018. Hot tonsillectomy, but not tonsillotomy, techniques were related to a higher risk for postoperative bleeding. The use of cold techniques increased for all types of surgeries. The rates of patients reporting contact due to postoperative pain were associated with indication and method, with the lowest rate reported for tonsillotomy (4.5% in 2018) and the highest for tonsillectomy (34.5% in 2009). The rate of patients reporting that their symptoms were gone 6 months after surgery decreased.Conclusions and significance: All hot tonsillectomy techniques should be avoided as they are related to a higher risk for postoperative bleeding. The high rate of postoperative contacts due to pain after tonsillectomy indicates a need for improvement in pain management. The declining rates of symptom relief must be investigated further.

Does tonsillectomy reduce medical care visits for pharyngitis/tonsillitis in children and adults? Retrospective cohort study from Sweden.

OBJECTIVE: To assess the effectiveness of tonsillectomy/adenotonsillectomy in reducing medical care visits for pharyngitis or tonsillitis in children and adults with chronic/recurrent tonsillitis. DESIGN: Retrospective cohort study. SETTING: Data were retrieved from the VEGA register, a comprehensive regional cohort in Sweden. PARTICIPANTS: 1044 children (<15 years) and 2244 adults. INTERVENTION: Tonsillectomy/adenotonsillectomy compared with no surgical treatment. MAIN OUTCOME MEASURES: Changes in yearly mean rates of medical care visits due to pharyngitis/tonsillitis. RESULTS: In children, there was a significant decrease in the yearly mean medical care visits rate from 1.93 (1.82 to 2.04) before surgery to 0.129 (0.099 to 0.165) after surgery, with a mean change of -1.80 (-1.90 to -1.69), p<0.0001. In patients who did not undergo surgery, the corresponding mean change was -1.51 (-1.61 to -1.41), resulting in a mean difference in the change in visit rates between the intervention and control groups of -0.283 (-0.436 to -0.135), p=0.0002. In adults, a significant decrease in the yearly mean medical care visit rate was observed from 1.45 (1.39 to 1.51) before surgery to 0.152 (0.132 to 0.173) after surgery, with a mean change of -1.30 (-1.36 to -1.24), p<0.0001, compared with -1.18 (-1.24 to -1.13) in the control group. The difference in the change in yearly mean visit rate between the surgical and non-surgical groups was -0.111 (-0.195 to -0.028), p=0.0097. The subgroup analysis showed a greater effect of surgery in children, in patients with a higher number of medical care visits before surgery and in the first year of follow-up. CONCLUSION: In this cohort of patients moderately or less affected with chronic/recurrent tonsillitis, the effectiveness of tonsillectomy/adenotonsillectomy in reducing medical care visits for pharyngitis and tonsillitis compared with no surgical treatment was low and of questionable clinical value.

Increasing Readmission Rates for Hemorrhage after Tonsil Surgery: A Longitudinal (26 Years) National Study.

Objective To investigate the readmission rates due to postoperative hemorrhage in relation to tonsil surgery clinical practice in a national population. Study Design Retrospective longitudinal population-based cohort study. Setting Based on register data from the Swedish National Patient Register (NPR). Subjects and Methods All benign tonsil operations (256 053) performed in Sweden from 1987 to 2013 were identified through a search in the NPR. For all identified cases, data on gender, age, date of surgery, indication, type of surgery, level of care, length of stay (LOS) for inpatient surgery, readmission and reoperation because of postoperative bleeding (within 31 days) were collected. Results Overall frequency of readmission for hemorrhage was 2.61%, and the reoperation rate for hemostasis was 0.84%. The longitudinal analysis showed an increase from 1% (1987) to 5% (2013) in readmissions caused by hemorrhage. Tonsillectomies, surgery performed for infectious disease, and surgery on adult patients (age >18 years) showed readmission rates approaching 10% (2013). Male gender, increasing age, tonsillectomy, infectious indication, and recent year of surgery were identified as risk factors for readmission and reoperation due to hemorrhage. An increasing share of patients readmitted for hemorrhage underwent reoperation for hemostasis: 18% (1987) versus 43% (2013). Conclusion Readmissions for hemorrhage have increased by a factor of 5 in Sweden from 1987 to 2013. The design of the study and the data in NPR do not allow determination of the true reasons behind the alarming results.

[An abscess in the tongue]. / Tungeabsces.

Abscesses of the tongue are rare and potentially life-threatening because of risk of airway obstruction. It is most often preceded by trauma. In this paper we present an otherwise healthy patient with an abscess in the tongue eleven days after a trauma involving the presence of an insect believed to be a spider in the mouth. The symptoms were oedema, redness and pain of the tongue. A computed tomography was used as a diagnostic tool. The abscess was successfully treated with incision and antibiotics. Abscess should be considered as a differential diagnosis in patients presenting with a swollen tongue.