Abstract
The objective of this study was to examine factors affecting morbidity after tonsillectomy in children. Data from the National Tonsil Surgery Register in Sweden on 18,712 patients who underwent tonsillectomy with or without simultaneous adenoidectomy between 1 and 18 years of age were analysed. This register includes data on sex, gender, surgical indication, and the surgical and haemostasis techniques used for each patient, as well as patient-reported outcomes for haemorrhage, analgesic use and antibiotic use. Comparison of patients who underwent surgery for infection versus upper airway obstruction revealed a significant increase in haemorrhage complications in the infection group. However, no significant difference remained after the adjustments for confounders in multivariable regression analysis. Instead, the increased risk among patients who underwent surgery for infection was mainly attributable to the use of bipolar diathermy and increased patient age. Patients who received surgery for infection reported more days of analgesic use, as well as more unplanned contacts with a health care service provider due to pain, compared with those who underwent surgery for upper airway obstruction. These results remained significant in multivariate analysis. The use of bipolar diathermy for haemostasis resulted in an increased risk, while the use of cold steel surgical instruments, a younger patient age and female sex led to a decreased risk. The surgical and haemostasis techniques used are the most important factors that affect morbidity after tonsillectomy in the paediatric age group. The choice of surgical techniques is of utmost importance for decreasing morbidity in these patients.
Similar content being viewed by others
References
Stalfors J, Ericsson E, Hemlin C, Hultcrantz E, Mansson I, Roos K et al (2012) Tonsil surgery efficiently relieves symptoms: analysis of 54,696 patients in the National Tonsil Surgery Register in Sweden. Acta Otolaryngol 132(5):533–539
Johnson LB, Elluru RG, Myer CM 3rd (2002) Complications of adenotonsillectomy. Laryngoscope 112(8 Pt 2 Suppl 100):35–36. PubMed PMID: 12172238
Perkins JN, Liang C, Gao D, Shultz L, Friedman NR (2012) Risk of post-tonsillectomy hemorrhage by clinical diagnosis. Laryngoscope 122(10):2311–2315
Myssiorek D, Alvi A (1996) Post-tonsillectomy hemorrhage: an assessment of risk factors. Int J Pediatr Otorhinolaryngol 37(1):35–43
Wei JL, Beatty CW, Gustafson RO (2000) Evaluation of post-tonsillectomy hemorrhage and risk factors. Otolaryngol Head Neck Surg Off J Am Acad Otolaryngol Head Neck Surg 123(3):229–235
Schrock A, Send T, Heukamp L, Gerstner AO, Bootz F, Jakob M (2009) The role of histology and other risk factors for post-tonsillectomy haemorrhage. Eur Arch Otorhinolaryngol Off J Eur Fed Otorhinolaryngol Soc 266(12):1983–1987
Tomkinson A, Harrison W, Owens D, Harris S, McClure V, Temple M (2011) Risk factors for postoperative hemorrhage following tonsillectomy. Laryngoscope 121(2):279–288
Ali RB, Smyth D, Kane R, Donnelly M (2008) Post-tonsillectomy bleeding: a regional hospital experience. Ir J Med Sci 177(4):297–301
Nunez DA, Provan J, Crawford M (2000) Postoperative tonsillectomy pain in pediatric patients: electrocautery (hot) vs cold dissection and snare tonsillectomy—a randomized trial. Arch Otolaryngol Head Neck Surg 126(7):837–841. PubMed PMID: 10888995
Kim MK, Lee JW, Kim MG, Ha SY, Lee JS, Yeo SG (2012) Analysis of prognostic factors for postoperative bleeding after tonsillectomy. Eur Arch Otorhinolaryngol Off J Eur Fed Otorhinolaryngol Soc 269(3):977–981
The National Tonsil Surgery Register in Sweden (2015) Annual Report 2013. ISSN: 2001-9718. www.entqualitysweden.se, webpage checked 10th July 2015
Lowe D, van der Meulen J, Cromwell D, Lewsey J, Copley L, Browne J et al (2007) Key messages from the National Prospective Tonsillectomy Audit. Laryngoscope 117(4):717–724
Hoddeson EK, Gourin CG (2009) Adult tonsillectomy: current indications and outcomes. Otolaryngol Head Neck Surg Off J Am Acad Otolaryngol Head Neck Surg 140(1):19–22
Windfuhr JP, Chen YS, Remmert S (2005) Hemorrhage following tonsillectomy and adenoidectomy in 15,218 patients. Otolaryngol Head Neck Surg Off J Am Acad Otolaryngol Head Neck Surg 132(2):281–286
Leinbach RF, Markwell SJ, Colliver JA, Lin SY (2003) Hot versus cold tonsillectomy: a systematic review of the literature. Otolaryngol Head Neck Surg Off J Am Acad Otolaryngol Head Neck Surg 129(4):360–364
Chimona T, Proimos E, Mamoulakis C, Tzanakakis M, Skoulakis CE, Papadakis CE (2008) Multiparametric comparison of cold knife tonsillectomy, radiofrequency excision and thermal welding tonsillectomy in children. Int J Pediatr Otorhinolaryngol 72(9):1431–1436
MacGregor FB, Albert DM, Bhattacharyya AK (1995) Post-operative morbidity following paediatric tonsillectomy; a comparison of bipolar diathermy dissection and blunt dissection. Int J Pediatr Otorhinolaryngol 31(1):1–6
Soderman AC, Odhagen E, Ericsson E, Hemlin C, Hultcrantz E, Sunnergren O et al (2015) Post-tonsillectomy haemorrhage rates are related to technique for dissection and for haemostasis. An analysis of 15,734 patients in the National Tonsil Surgery Register in Sweden. Clin Otolaryngol Off J ENT UK Off J Neth Soc Otorhinolaryngol Cervico-Facialbv Surg 40(3):248–254
Aydin S, Taskin U, Altas B, Erdil M, Senturk T, Celebi S et al (2014) Post-tonsillectomy morbidities: randomised, prospective controlled clinical trial of cold dissection versus thermal welding tonsillectomy. J Laryngol Otol 128(2):163–165
Oko MO, Ganly I, Loughran S, Clement WA, Young D, Geddes NK (2005) A prospective randomized single-blind trial comparing ultrasonic scalpel tonsillectomy with tonsillectomy by blunt dissection in a pediatric age group. Otolaryngol Head Neck Surg Off J Am Acad Otolaryngol Head Neck Surg 133(4):579–584. PubMed PMID: 16213933
Hahn CH, Rungby JA, Overgaard T, Moller H, Schultz P, Tos M (2009) Effect of diathermy on pain and healing in tonsillectomy, compared with other methods of haemostasis: a randomised study. J Laryngol Otol 123(6):648–655
Ersozlu T, Yildirim YS, Sarica S (2013) Comparison of pediatric and adult tonsillectomies performed by thermal welding system. Int J Otolaryngol 2013:265105. PubMed PMID: 24369468. Pubmed Central PMCID: 3863564
Lavy JA (1997) Post-tonsillectomy pain: the difference between younger and older patients. Int J Pediatr Otorhinolaryngol 42(1):11–15
Krishna P, LaPage MJ, Hughes LF, Lin SY (2004) Current practice patterns in tonsillectomy and perioperative care. Int J Pediatr Otorhinolaryngol 68(6):779–784
Dhiwakar M, Clement WA, Supriya M, McKerrow W (2010) Antibiotics to reduce post-tonsillectomy morbidity. Cochrane Database Syst Rev (7):CD005607. doi:10.1002/14651858.CD005607.pub3
Acknowledgments
We thank Statistiska Konsultgruppen AB, and especially Bengt Bengtsson for helping with statistical analyses.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Elinder, K., Söderman, AC.H., Stalfors, J. et al. Factors influencing morbidity after paediatric tonsillectomy: a study of 18,712 patients in the National Tonsil Surgery Register in Sweden. Eur Arch Otorhinolaryngol 273, 2249–2256 (2016). https://doi.org/10.1007/s00405-016-4001-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-016-4001-x