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Regional variability of hemorrhage following tonsil surgery in 1,520,234 cases

  • Head and Neck
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European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate, whether the regional variability of tonsil surgery in terms of the 16 Federal States of Germany was mirrored by a comparable variability of bleeding complications in male and female patients.

Methods

A longitudinal population-based inpatient cohort study was performed including all patients who had undergone tonsil surgery between 2005 and 2018. The database was provided by the Federal Statistical Office of Germany and included all inpatient cases after tonsillectomy (with or without adenoidectomy), tonsillotomy, abscess-tonsillectomy and secondary tonsillectomy. The population was stratified by region (16 Federal States) and gender. Operation rates were calculated in relation to the end-year population number of each region. Bleeding percentages were calculated for each calendar year and region as the number of procedures to achieve hemostasis divided by the total number of operations.

Results

The surgical rates varied significantly between the 16 Federal States in male, female and all patients (p = 0.001). Revision surgery to achieve hemostasis was predominantly performed in male patients (5.2–11.4% male vs. 3.7–7.6% female patients). Bleeding percentages did not differ significantly from national values in male and female patients in 5 Federal States, but were significantly higher than the national average in 3 Federal States and significantly lower in 7 Federal States for both genders (p < 0.05), while in 1 Federal State it was significantly lower only for the male patients. Pearson’s correlation coefficient for surgical and bleeding rates was positive and statistically significant (p < 0.05) for all Federal States, except for two. This phenomenon was emphasized by female gender.

Conclusions

Gender had an impact not only on surgical rates but also on bleeding percentages and this was independent from the decrease in the total number of operations. Surprisingly, there was a clear correlation between the rates of both variables in the majority of the Federal States of Germany. It needs further studies to clarify, why a higher prevalence of surgical practice, thus surgical experience, was not followed by lower bleeding complications.

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Abbreviations

SLH:

Schleswig–Holstein

HH:

Hamburg

NS:

Niedersachsen

BR:

Bremen

NRW:

Nordrhein–Westfalen

HE:

Hessen

RLP:

Rheinland–Pfalz

BW:

Baden–Württemberg

BA:

Bayern

SAA:

Saarland

BER:

Berlin

BRA:

Brandenburg

MV:

Mecklenburg–Vorpommern

SAC:

Sachsen

SAN:

Sachsen–Anhalt

TH:

Thüringen

TE:

Tonsillectomy

ATE:

Tonsillectomy with adenoidectomy

TT:

Tonsillotomy

References

  1. Appleby J, Raleigh V, Frosini F et al (2011) Variations in health care. The good, the bad and the inexplicable. London

  2. Elinder K, Hessen Soderman AC, Stalfors J et al (2016) 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

    Article  Google Scholar 

  3. Faktencheck-Gesundheit.De/De/Publikationen/Publikation/Did/Faktencheck-Gesundheit-Gaumenmandeln. 2013. Accessed 20 Feb 2020

  4. Fedeli U, Marchesan M, Avossa F et al (2009) Variability of adenoidectomy/tonsillectomy rates among children of the Veneto Region. Italy BMC Health Serv Res 9:25

    Article  Google Scholar 

  5. Glover JA (1938) The incidence of tonsillectomy in school children: (section of epidemiology and state medicine). Proc R Soc Med 31:1219–1236

    PubMed  PubMed Central  CAS  Google Scholar 

  6. Hinton-Bayre AD, Noonan K, Ling S et al (2017) Experience is more important than technology inpaediatric post-tonsillectomy bleeding. J Laryngol Otol 131:35–40

    Article  Google Scholar 

  7. Hsueh WY, Hsu WC, Ko JY et al (2018) Population-based survey of inpatient pediatric tonsillectomy and postoperative hemorrhage in Taiwan, 1997–2012. Int J Pediatr Otorhinolaryngol 108:55–62

    Article  Google Scholar 

  8. Lechner M, Chandrasekharan D, Vithlani R et al (2017) Evaluation of a newly introduced tonsillectomy operation record for the analysis of a regional post-tonsilectomy bleed data: a quality improvement project at the London North West Healthcare NHS Trust. BMJ Open Quality 6:e000055

    Article  Google Scholar 

  9. Liu JH, Anderson KE, Willging JP et al (2001) Posttonsillectomy hemorrhage: what is it and what should be recorded? Arch Otolaryngol Head Neck Surg 127:1271–1275

    Article  CAS  Google Scholar 

  10. Lowe D, Van Der Meulen J, Audit NPT (2004) Tonsillectomy technique as a risk factor for postoperative hemorrhage. Lancet 364:642–643

    Article  Google Scholar 

  11. Lowe D, Van Der Meulen J, Cromwell D et al (2007) Key messages from the national prospective tonsillectomy audit. Laryngoscope 117:717–724

    Article  Google Scholar 

  12. Mitchell RB, Archer SM, Ishman SL et al (2019) Clinical practice guideline: tonsillectomy in children (update). Otolaryngol Head Neck Surg 160:S1–S42

    Article  Google Scholar 

  13. Ostvoll E, Sunnergren O, Stalfors J (2018) Increasing readmission rates for hemorrhage after tonsil surgery: a longitudinal (26 years) national study. Otolaryngol Head Neck Surg 158:167–176

    Article  Google Scholar 

  14. Sarny S, Ossimitz G, Habermann W et al (2012) The Austrian tonsil study 2010–part 1: statistical overview. Laryngorhinootologie 91:16–21

    Article  CAS  Google Scholar 

  15. Sarny S, Ossimitz G, Habermann W et al (2013) Austrian tonsil study part 3: surgical technique and postoperative haemorrhage after tonsillectomy. Laryngorhinootologie 92:92–96

    PubMed  CAS  Google Scholar 

  16. Soderman AC, Odhagen E, Ericsson E et al (2015) Post-tonsillectomy haemorrhage rates are related to technique for dissection and for haemostasis. An analysis of 15734 patients in the National Tonsil Surgery Register in Sweden. Clin Otolaryngol 40:248–254

    Article  Google Scholar 

  17. Spektor Z, Saint-Victor S, Kay DJ et al (2016) Risk factors for pediatric post-tonsillectomy hemorrhage. Int J Pediatr Otorhinolaryngol 84:151–155

    Article  Google Scholar 

  18. Stalfors J, Ericsson E, Hemlin C et al (2013) Annual report 2013. The National Tonsil Surrey Regisetr in Sweden https://www.registercentrum.blob.core.windows.net/orl/r/-rsrapport-2013-Tonsilloperationsregistrets-engelska-version-ByOVNca.pdf. Accessed 19 Apr 2020

  19. Suleman M, Clark MP, Goldacre M et al (2010) Exploring the variation in paediatric tonsillectomy rates between English regions: a 5-year NHS and independent sector data analysis. Clin Otolaryngol 35:111–117

    Article  CAS  Google Scholar 

  20. Van Den Akker EH, Hoes AW, Burton MJ et al (2004) Large international differences in (adeno)tonsillectomy rates. Clin Otolaryngol Allied Sci 29:161–164

    Article  Google Scholar 

  21. Wei JL, Beatty CW, Gustafson RO (2000) Evaluation of posttonsillectomy hemorrhage and risk factors. Otolaryngol Head Neck Surg 123:229–235

    Article  CAS  Google Scholar 

  22. Wennberg J, Gittelsohn A (1973) Small area variations in health care delivery. Science 182:1102–1108

    Article  CAS  Google Scholar 

  23. Windfuhr JP (2013) Faults and failure of tonsil surgery and other standard procedures in otorhinolaryngology. Laryngorhinootologie 92(Suppl 1):S33–72

    PubMed  Google Scholar 

  24. Windfuhr JP (2016) Indications for tonsillectomy stratified by the level of evidence. GMS Curr Top Otorhinolaryngol Head Neck Surg 15:Doc09

  25. Windfuhr JP (2013) Serious complications following tonsillectomy: how frequent are they really? ORL J Otorhinolaryngol Relat Spec 75:166–173

    Article  Google Scholar 

  26. Windfuhr JP, Chen YS (2019) Do changing trends in tonsil surgery affect hemorrhage rates? A longitudinal study covering 1,452,637 procedures. Eur Arch Otorhinolaryngol 276:2585–2593

    Article  Google Scholar 

  27. Windfuhr JP, Chen YS (2019) Tonsil surgery in the federal states of Germany: similarities and differences. HNO

  28. Windfuhr JP, Wienke A, Chen YS (2009) Electrosurgery as a risk factor for secondary post-tonsillectomy hemorrhage. Eur Arch Otorhinolaryngol 266:111–116

    Article  CAS  Google Scholar 

  29. https://www.destatis.de. Accessed 26 Nov 2018

  30. https://www.gba.ge. Accessed 28 Nov 2018

  31. https://www.gbe-bund.de. Accessed 01 Oct 2020

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Plastic Head and Neck Surgery, Kliniken Maria Hilf, Viersener Str. 450, 41063, Mönchengladbach, Germany

    Jochen P. Windfuhr & Christina Hendricks

  2. Aristotle University of Thessaloniki, Thessaloniki, Greece

    Paraskevi Alizoti

Authors
  1. Jochen P. Windfuhr
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  2. Paraskevi Alizoti
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  3. Christina Hendricks
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Correspondence to Jochen P. Windfuhr.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors. According to the policy of the IRB responsible for the authors, this study was exempt from ethical approval, because it was a secondary analysis of a publicly available dataset with anonymous data.

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Windfuhr, J.P., Alizoti, P. & Hendricks, C. Regional variability of hemorrhage following tonsil surgery in 1,520,234 cases. Eur Arch Otorhinolaryngol 277, 3169–3177 (2020). https://doi.org/10.1007/s00405-020-06080-x

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  • DOI: https://doi.org/10.1007/s00405-020-06080-x

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