Skip to main content

Advertisement

SpringerLink
Log in

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

  • Review Article
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Official webpage of Swedish National Quality Registries. http://www.kvalitetsregister.se/. Accessed 12 Apr 2017

  2. National Institute of Health and Welfare, Finland (2017). https://www.thl.fi/en/web/thlfi-en. Accessed 24 Jul 2017

  3. Official webpage of Norwegian national quality register (2017). https://www.kvalitetsregistre.no. Accessed 20 Sep 2017

  4. Statens Serum Institute, Denmark (2017). http://www.ssi.dk/English.aspx. Accessed 24 Jul 2017

  5. Hessen Soderman AC, Ericsson E, Hemlin C, Hultcrantz E, Mansson I, Roos K, Stalfors J (2011) Reduced risk of primary postoperative hemorrhage after tonsil surgery in Sweden: results from the National Tonsil Surgery Register in Sweden covering more than 10 years and 54,696 operations. Laryngoscope 121(11):2322–2326

    Article  PubMed  Google Scholar 

  6. Hultcrantz E, Ericsson E (2013) Factors influencing the indication for tonsillectomy: a historical overview and current concepts. ORL J Otorhinolaryngol Relat Spec 75(3):184–191

    Article  PubMed  Google Scholar 

  7. Windfuhr JP, Toepfner N, Steffen G, Waldfahrer F, Berner R (2016) Clinical practice guideline: tonsillitis II. Surgical management. Eur Arch Oto-Rhino-Laryngol 273(4):989–1009

    Article  Google Scholar 

  8. Burton MJ, Glasziou PP, Chong LY, Venekamp RP (2014) Tonsillectomy or adenotonsillectomy versus non-surgical treatment for chronic/recurrent acute tonsillitis. Cochrane Database Syst Rev 11:CD001802

    Google Scholar 

  9. Hollis LJ, Burton MJ, Millar JM (2000) Perioperative local anaesthesia for reducing pain following tonsillectomy. Cochrane Database Syst Rev 2(2):CD001874

    Google Scholar 

  10. Lim J, McKean MC (2009) Adenotonsillectomy for obstructive sleep apnoea in children. Cochrane Database Syst Rev 2:CD003136

    Google Scholar 

  11. Pinder DK, Wilson H, Hilton MP (2011) Dissection versus diathermy for tonsillectomy. Cochrane Database Syst Rev 3:CD002211

    Google Scholar 

  12. Croft P, Malmivaara A, van Tulder M (2011) The pros and cons of evidence-based medicine. Spine (Phila Pa 1976) 36(17):E1121–E1125

    Article  Google Scholar 

  13. Malmivaara A (2013) Real-effectiveness medicine-pursuing the best effectiveness in the ordinary care of patients. Ann Med 45(2):103–106

    Article  PubMed  Google Scholar 

  14. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62(10):1006–1012

    Article  PubMed  Google Scholar 

  15. Drolet BC, Johnson KB (2008) Categorizing the world of registries. J Biomed Inform 41(6):1009–1020

    Article  PubMed  Google Scholar 

  16. Stalfors J, Ericsson E, Hemlin C, Hultcrantz E, Mansson I, Roos K, Hessen Soderman AC (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

    Article  PubMed  Google Scholar 

  17. Soderman AC, Odhagen E, Ericsson E, Hemlin C, Hultcrantz E, Sunnergren O, Stalfors J (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(3):248–254

    Article  PubMed  Google Scholar 

  18. Sunnergren O, Hemlin C, Ericsson E, Hessen-Soderman AC, Hultcrantz E, Odhagen E, Stalfors J (2014) Radiofrequency tonsillotomy in Sweden 2009–2012. Eur Arch Otorhinolaryngol 271(6):1823–1827

    Article  PubMed  Google Scholar 

  19. Hultcrantz E, Ericsson E, Hemlin C, Hessen-Soderman AC, Roos K, Sunnergren O, Stalfors J (2013) Paradigm shift in Sweden from tonsillectomy to tonsillotomy for children with upper airway obstructive symptoms due to tonsillar hypertrophy. Eur Arch Otorhinolaryngol 270(9):2531–2536

    Article  PubMed  Google Scholar 

  20. Ericsson E, Brattwall M, Lundeberg S (2015) Swedish guidelines for the treatment of pain in tonsil surgery in pediatric patients up to 18 years. Int J Pediatr Otorhinolaryngol 79(4):443–450

    Article  PubMed  CAS  Google Scholar 

  21. Elinder K, Soderman AC, Stalfors J, Knutsson J (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(8):2249–2256

    Article  PubMed  Google Scholar 

  22. Ostvoll E, Sunnergren O, Ericsson E, Hemlin C, Hultcrantz E, Odhagen E, Stalfors J (2015) Mortality after tonsil surgery, a population study, covering eight years and 82,527 operations in Sweden. Eur Arch Otorhinolaryngol 272(3):737–743

    Article  PubMed  Google Scholar 

  23. 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

    Article  PubMed  Google Scholar 

  24. Public Health Wales annual report 2015: Tonsillectomy and adenoidectomy single-use instrument surveillance (2016). http://www.wales.nhs.uk/sites3/Documents/457/All%20Wales%20Annual%20Tonsillectomy%20and%20Adenoidectomy%20Single-Use%20Instrument%20Surveillance%20Report%202015.pdf. Accessed 20 Feb 2018

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

    Article  PubMed  CAS  Google Scholar 

  26. Sarny S, Habermann W, Ossimitz G, Stammberger H (2012) The Austrian Tonsil Study 2010—Part 2: postoperative haemorrhage. Laryngorhinootologie 91(2):98–102

    Article  PubMed  CAS  Google Scholar 

  27. Sarny S, Ossimitz G, Habermann W, Stammberger H (2013) Austrian tonsil study part 3: surgical technique and postoperative haemorrhage after tonsillectomy. Laryngorhinootologie 92(2):92–96

    PubMed  CAS  Google Scholar 

  28. Sarny S, Habermann W, Ossimitz G, Stammberger H (2013) What lessons can be learned from the Austrian events? ORL J Otorhinolaryngol Relat Spec 75(3):175–181

    Article  PubMed  Google Scholar 

  29. The Royal College of Surgeons of England, England (2005) National Prospective Tonsillectomy Audit final report. The Royal College of Surgeons of England

  30. Lowe D, van der Meulen J, Cromwell D et al (2007) Key messages from the national prospective tonsillectomy audit. Laryngoscope 117(4):717–724

    Article  PubMed  Google Scholar 

  31. Audit NP (2008) Impact of NICE guidance on rates of haemorrhage after tonsillectomy: an evaluation of guidance issued during an ongoing national tonsillectomy audit. Qual Saf Health Care 17(4):264–268

    Article  PubMed  Google Scholar 

  32. Blanchford H, Lowe D (2013) Cold versus hot tonsillectomy: state of the art and recommendations. ORL J Otorhinolaryngol Relat Spec 75(3):136–141

    Article  PubMed  Google Scholar 

  33. Lowe D, van der Meulen J, National Prospective Tonsillectomy Audit (2004) Tonsillectomy technique as a risk factor for postoperative haemorrhage. Lancet 364(9435):697–702

    Article  PubMed  CAS  Google Scholar 

  34. Scotland Scottish Otolaryngology Society (2008) A Scottish prospective audit of tonsil and adenoid surgery with disposable surgical instruments—Final report

  35. Blair RL, McKerrow WS, Carter NW, Fenton A (1996) The Scottish tonsillectomy audit. Audit Sub-Committee of the Scottish Otolaryngological Society. J Laryngol Otol 110(Suppl 20):1–25

    PubMed  Google Scholar 

  36. Officiel webpages for tonsil surgery register of Sweden (2017) https://ton.registercentrum.se. Accessed 20 Feb 2018

  37. Department of Health. Risk assessment for transmission of vCJD via surgical instruments: a modelling approach and numerical scenarios (2001). http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4084657.pdf. Accessed 20 Feb 2018

  38. Public Health Wales Clinical Instrument Surveillance Program webpage (2015). http://www.wales.nhs.uk/sites3/page.cfm?orgid=457&pid=53285. Accessed 23 Mar 2018

  39. Bergqvist D, Bjorck M, Lees T, Menyhei G (2014) Validation of the VASCUNET registry—pilot study. Vasa 43(2):141–144

    Article  PubMed  Google Scholar 

  40. de By TM, Mohacsi P, Gummert J et al (2015) The European Registry for Patients with Mechanical Circulatory Support (EUROMACS): first annual report. Eur J Cardiothorac Surg 47(5):770–776

    Article  PubMed  Google Scholar 

  41. Elefteriades JA, Ziganshin BA (2015) Gratitude to the international registry of acute aortic dissection from the aortic community. J Am Coll Cardiol 66(4):359–362

    Article  PubMed  Google Scholar 

  42. Havelin LI, Fenstad AM, Salomonsson R et al (2009) The Nordic Arthroplasty Register Association: a unique collaboration between 3 national hip arthroplasty registries with 280,201 THRs. Acta Orthop 80(4):393–401

    Article  PubMed  PubMed Central  Google Scholar 

  43. Marks W, Bailey L, Sanger TD (2017) PEDiDBS: the pediatric international deep brain stimulation registry project. Eur J Paediatr Neurol 21(1):218–222

    Article  PubMed  Google Scholar 

  44. Petruzzo P, Lanzetta M, Dubernard JM et al (2010) The international registry on hand and composite tissue transplantation. Transplantation 90(12):1590–1594

    Article  PubMed  Google Scholar 

  45. Stehlik J, Hosenpud JD, Edwards LB, Hertz MI, Mehra MR, International Society for Heart and Lung Transplantation (2013) ISHLT international registry for heart and lung transplantation—into the fourth decade, from strength to strength. J Heart Lung Transplant 32(10):941–950

    Article  PubMed  Google Scholar 

  46. Vallabhaneni SR, Harris PL (2001) Lessons learnt from the EUROSTAR registry on endovascular repair of abdominal aortic aneurysm repair. Eur J Radiol 39(1):34–41

    Article  PubMed  CAS  Google Scholar 

  47. Levine MN, Julian JA (2008) Registries that show efficacy: good, but not good enough. J Clin Oncol 26(33):5316–5319

    Article  PubMed  Google Scholar 

  48. Porter M, Teisberg E (2006) Redefining health care: creating value-based competition on results. Harvard Business Press, Boston

    Google Scholar 

  49. The International Consortium for Health Outcomes Measurement (2015) What matters most: patient outcomes and the transformation of health care. http://www.ichom.org/book/. Accessed 13 Sep 2017

  50. Stalfors J, Ericsson E, Hemlin C, Hessen Soderman AC, Odhagen E, Sunnergren O (2014) Annual report for the National Tonsil Surgery Register in Sweden 2013. Karolinska University Hospital. Stockholm, Sweden

  51. Officiel webpage of The National Tonsil Surgery Register of Sweden. https://ton.registercentrum.se/. Accessed 12 Sep 2017

  52. Ludvigsson JF, Andersson E, Ekbom A et al (2011) External review and validation of the Swedish national inpatient register. BMC Public Health 11:450-2458-11-450

    Article  Google Scholar 

  53. Organization for Economic Co-operation and Development, OECD. Statistics of surgical procedures 2014. http://stats.oecd.org/. Accessed 20 Feb 2018

  54. National Institute of Health and Welfare, Finland. Specialised Health Care - Database of Annual Number of Preocedures (in Finnish). https://sampo.thl.fi/pivot/prod/fi/thil/perus01/fact_thil_perus01?row=operation_type-189769&column=time-6656. Accessed 23 Mar 2018

  55. Norwegian Patient Register (2017) Annual number of tonsil surgery procedures in 2014. https://helsedirektoratet.no/english/norwegian-patient-registry 

  56. Månsson I (ed) (2009) Report on indications for tonsil surgery in Sweden (in Swedish). Sveriges Kommuner och Landsting, Stockholm, Sweden

  57. Ministry of Social Affairs and Health (2010) Uniform criteria for access to non-emergency treatment 2010. 2nd edn. (in Finnish). Helsinki, Finland

  58. National clinical guideline for the removal of tonsils (tonsillectomy) (2016) Danish Health Authority. https://www.sst.dk/en/publications/2016/~/media/EB34FB643B2743C698CB445B775EAE9B.ashx. Accessed 23 Mar 2018

  59. Wiksten J, Blomgren K, Eriksson T, Guldfred L, Bratt M, Pitkaranta A (2014) Variations in treatment of peritonsillar abscess in four Nordic countries. Acta Otolaryngol 134(8):813–817

    Article  PubMed  CAS  Google Scholar 

Download references

Funding

This study was funded by NordForsk foundation (Grant no. 971274255).

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, 00029, Helsinki, Finland

    Johanna Ruohoalho, Leif Bäck & Antti Mäkitie

  2. Department of Otorhinolaryngology, Head and Neck Surgery, Sahlgrenska University Hospital, P.O. Sahlgrenska Universitetssjukhuset, 413 45, Göteborg, Sweden

    Eirik Østvoll

  3. Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, P.O. Box 426, 405 30, Göteborg, Sweden

    Eirik Østvoll & Joacim Stalfors

  4. Department of Otorhinolaryngology, Head and Neck Surgery, St Olav’s University Hospital, Sluppen, P.O. Box 3250, 7006, Trondheim, Norway

    Mette Bratt & Vegard Bugten

  5. Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway

    Vegard Bugten

  6. Department of Otorhinolaryngology, Region Hospital Holstebro, Institute of Clinical Medicine, Aarhus University, Noerrebrogade 44, 8000, Århus C, Denmark

    Therese Ovesen

  7. Sheikh Khalifa Medical City, Ajman, United Arab Emirates

    Joacim Stalfors

Authors
  1. Johanna Ruohoalho
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eirik Østvoll
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mette Bratt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vegard Bugten
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Leif Bäck
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Antti Mäkitie
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Therese Ovesen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Joacim Stalfors
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Johanna Ruohoalho.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Disclaimer

Data from the Norwegian Patient Register has been used in this publication. The interpretation and reporting of these data are the sole responsibility of the authors, and no endorsement by the Norwegian patient register is intended nor should be inferred.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ruohoalho, J., Østvoll, E., Bratt, M. et al. Systematic review of tonsil surgery quality registers and introduction of the Nordic Tonsil Surgery Register Collaboration. Eur Arch Otorhinolaryngol 275, 1353–1363 (2018). https://doi.org/10.1007/s00405-018-4945-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-018-4945-0

Keywords

Search

Navigation