Comparison of clinical practice of tonsil surgery from quality register data from Sweden and Norway and one clinic in Denmark

Stalfors, Joacim; Ovesen, Therese; Bertelsen, Jannik Buus; Bugten, Vegard; Wennberg, Siri; Sunnergren, Ola

doi:10.1136/bmjopen-2021-056551

Cited by 5 publications

(4 citation statements)

References 21 publications

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“…At least the dramatic reduction of tonsillectomies after implementation of the SIGN guidelines was also seen in the United Kingdom 11 , 12 . In contrast, countries with lower cut-off for indication of tonsil surgery like in Scandinavia with ≥ 3 episodes report constant higher number of surgery 13 , 14 .…”

Section: Discussionmentioning

confidence: 93%

Effect of the German tonsillitis guideline on indication for tonsil surgery in patients with recurrent acute tonsillitis: a population-based study

Betz,

Boeger,

Buentzel

et al. 2023

Sci Rep

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Evidence-based indication for tonsil surgery in patients with recurrent acute tonsillitis (RAT) is an ongoing matter of debate. Since introduction of the German tonsillitis guideline in 2015, the indication criteria for tonsil surgery have become much stricter. It is unclear, if this has changed the indication policy. A retrospective population-based study was performed including all 1398 patients with RAT admitted for tonsil surgery in all Thuringian hospitals in 2011, 2015, and 2019. Changes over the years concerning patients’ characteristics, number of tonsillitis episodes in the last 12 months treated with antibiotics (T12), and decision for tonsillectomy or tonsillotomy were analyzed using univariable and multivariable statistics. The surgical rates decreased from 28.56/100,000 population in 2011 to 23.57 in 2015, and to 11.60 in 2019. The relative amount of patients with ≥ 6 T12 increased from 14.1% in 2011 over 13.3% in 2015 to 35.9% in 2019. Most patients received a tonsillectomy (98% of all surgeries). Decision for tonsillotomy was seldom (1.2%). Multinomial logistic regression analysis with the year 2011 as reference showed that compared to the year 2015, the age of the patients undergoing surgery increased in 2015 (Odds ratio [OR] = 1.024; 95% confidence interval [CI] = 1.014–1.034; p < 0.001), and also in 2019 (OR 1.030: CI 1.017–1.043; p < 0.001). Compared to 2011, the number T12 was not higher in 2015, but in 2019 (OR 1.273; CI 1.185–1.367; p < 0.001). Stricter rules led to lower tonsil surgery rates but to a higher proportion of patients with ≥ 6 T12 before surgery. Tonsillectomy remained the dominating technique.

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Section: Discussionmentioning

confidence: 93%

Effect of the German tonsillitis guideline on indication for tonsil surgery in patients with recurrent acute tonsillitis: a population-based study

Betz,

Boeger,

Buentzel

et al. 2023

Sci Rep

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“…In Sweden, the National Tonsil Surgery Register ( https://ton.registercentrum.se/ ) is used since 1997 ( 77 ). Such quality registers have also been established in Norway and Denmark since 2016 ( 78 ). With the aim to improve the care of patients needing tonsil surgery, these registers allow an ongoing investigation of indications, surgical methods, and complications.…”

Section: Resultsmentioning

confidence: 99%

Treatment of recurrent acute tonsillitis—a systematic review and clinical practice recommendations

Guntinas-Lichius,

Geißler,

Mäkitie

et al. 2023

Front. Surg.

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BackgroundThere is an ongoing debate on the indications for tonsil surgery in both children and adults with recurrent acute tonsillitis. The aim is to provide practical recommendations for diagnostics and treatment for recurrent acute tonsillitis including evidence-based decision making for tonsillectomy.MethodsA systematic literature search in PubMed, Embase, Web of Science, and ScienceDirect from 2014 until April 2023 resulted in 68 articles. These were the basis for the review and a comprehensive series of consensus statements on the most important diagnostics and indications for both non-surgical and surgical therapy. A consensus paper was circulated among the authors and members of the International Head and Neck Scientific Group until a final agreement was reached for all recommendations.ResultsThe differentiation between sore throat and tonsillitis patient episodes is mostly not feasible and hence is not relevant for diagnostic decision making. Diagnostics of a tonsillitis/sore throat episode should always include a classification with a scoring system (Centor, McIssac, FeverPAIN score) to estimate the probability of a bacterial tonsillitis, mainly due to group A streptococcus (GAS). In ambiguous cases, a point-of-care test GAS swab test is helpful. Consecutive counting of the tonsillitis/sore throat episodes is important. In addition, a specific quality of life score (Tonsillectomy Outcome Inventory 14 or Tonsil and Adenoid Health Status Instrument) should be used for each episode. Conservative treatment includes a combination of paracetamol and/or non-steroidal anti-inflammatory drugs. In case of high probability of bacterial tonsillitis, and only in such cases, especially in patients at risk, standard antibiotic treatment is initiated directly or by delayed prescription. Tonsillectomy is indicated and is highly effective if the patient has had ≥7 adequately treated episodes in the preceding year, ≥5 such episodes in each of the preceding 2 years, or ≥3 such episodes in each of the preceding 3 years. An essential part of surgery is standardized pain management because severe postoperative pain can be expected in most patients.ConclusionIt is necessary to follow a stringent treatment algorithm for an optimal and evidence-based treatment for patients with recurrent acute tonsillitis. This will help decrease worldwide treatment variability, antibiotic overuse, and avoid ineffective tonsillectomy.

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“…Adenotonsillar surgery is one of the most common surgical procedures among children worldwide. In Sweden, approximately 5000–8000 surgeries of this kind are performed annually 9,10 . Yet even if the adenotonsillar surgery often improves a child's signs and symptoms, it may not always cure the child of OSA.…”

Section: Introductionmentioning

confidence: 99%

“…In Sweden, approximately 5000–8000 surgeries of this kind are performed annually. 9 , 10 Yet even if the adenotonsillar surgery often improves a child's signs and symptoms, it may not always cure the child of OSA. The number of persistent OSA cases differs depending on the patient's age, morbidity in the population, and the level of the apneahypopnea index (AHI) or the obstructive apneahypopnea index (OAHI).…”

Section: Introductionmentioning

confidence: 99%

Correlations between objective and subjective outcomes after adenotonsillar surgery in children with OSA

Sjölander

Borgström

Nerfeldt

et al. 2022

Laryngoscope Investig Oto

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Objectives: To investigate whether the OSA-18 questionnaire and a postoperative patient-reported outcome measure (PROM) question correlated with polysomnography (PSG) data.Methods: A prospective study of otherwise healthy young children with moderate to severe obstructive sleep apnea (OSA) to investigate if the obstructive apneahypopnea index (OAHI) before and 6-12 months after adenotonsil surgery correlated with the OSA-18 total symptom score (TSS) and the sleep disturbance subscale (SDS), as well as a PROM question on symptom improvement with responses on a 4-grade Likert scale.Results: Of 201 children, 173 (86%) had complete data of OAHI and OSA-18 preand postoperatively. The mean age was 3.2 years (SD 1.0) and the mean OAHI was 15.9 (11.3). Significant correlations between changes in the OAHI and OSA-18 were found, both TSS (r = 0.29, p < .001) and SDS (r = 0.53, p < .001). A total of 136 (68%) patients responded to the PROM question, the majority of whose symptoms had disappeared (n = 102) or almost disappeared (n = 30). Four patients had unchanged symptoms, and none had worsening symptoms. A correlation was found between the PROM question and a change in the OAHI (r = 0.36, p < .001), as well as a change in the OSA-18 TSS (r = 0.24, p = .006) and the SDS (r = 0.34, p < .001).The specificity of the PROM question for prediction of a postoperative OAHI < 2 was 82%, and the sensitivity was 38%. Conclusion:Changes in the OAHI significantly correlated with changes in the OSA-18, especially with the sleep disturbance scale, which could be an alternative for evaluation at follow-ups.

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Comparison of clinical practice of tonsil surgery from quality register data from Sweden and Norway and one clinic in Denmark

Cited by 5 publications

References 21 publications

Effect of the German tonsillitis guideline on indication for tonsil surgery in patients with recurrent acute tonsillitis: a population-based study

Effect of the German tonsillitis guideline on indication for tonsil surgery in patients with recurrent acute tonsillitis: a population-based study

Treatment of recurrent acute tonsillitis—a systematic review and clinical practice recommendations

Correlations between objective and subjective outcomes after adenotonsillar surgery in children with OSA

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