汎スコットランドの扁桃腺摘出術の転帰：全国横断的研究

Pan-Scotland tonsillectomy outcomes: a national cross-sectional study.

• Thomas D Milner
• Omar Hilmi
• John Marshall
• Kenneth MacKenzie

抄録

目的:

OBJECTIVES: The aim of this study was to assess the current post-tonsillectomy haemorrhage and return to theatre rates in Scotland DESIGN: National cross-sectional study PARTICIPANTS AND SETTING: Tonsillectomy outcomes data were collated for all NHS patients undergoing tonsillectomy in Scotland between 1998-2002 and 2013-2017 MAIN OUTCOME MEASURES: Using Information Services Division (ISD) Scotland retrospective data, 30-day readmission and 30-day return to theatre rates allowed an assessment of post-tonsillectomy haemorrhage rates. Data were validated through comparison with an audit conducted in NHS Greater Glasgow & Clyde between 2015-2016.

結果:

1998年から2002年の間に27,819例、2013年から2017年の間に23,184例の患者で、舌切断術が実施された。30日以内の再入院率は、1998-2002年と2013-2017年の間に、小児患者では4.7％から12.1％、成人患者では9.8％から19.9％と、両コホート間で大幅に増加した。同様に、30日後の「劇場復帰率」も両コホート間で増加しており、小児患者では1.2％から1.7％、成人患者では3.6％から4.9％となっています。再入院率と手術室への復帰率は、各コホートの成人と小児の扁桃腺摘出術の両方において、保健委員会間でほぼ同じであった。

RESULTS: Tonsillectomy was performed in 27,819 patients between 1998-2002, and 23,184 patients between 2013-2017. 30-day readmission rates increased considerably between the 1998-2002 and 2013-2017 cohorts, from 4.7% to 12.1% in paediatric patients, and 9.8% to 19.9% in adult patients. Similarly, 30-day 'return to theatre rates' increased between the two cohorts, from 1.2% to 1.7% in paediatric patients, and 3.6% to 4.9% in adult patients. Re-admission and return to theatre rates were similar across Health Boards for both adult and paediatric tonsillectomies in each cohort.

結論:

現在の30日以内の再入院率と手術室への復帰率は、現在までに報告された多くのシリーズよりも有意に高い。コホート間での扁桃腺摘出術の出血率の上昇は多因子によるものと考えられるが、これは過去の率を過小評価していたことや、扁桃腺摘出術患者のプロファイルの変化を反映している可能性がある。これらの扁桃摘出術の結果はスコットランドのすべての医療機関で同様であるため、現在の診療の詳細な監査が必要である。最も重要なのは、正確な患者の同意と非選択的耳鼻咽喉科サービスの提供への影響である。

CONCLUSIONS: Current 30-day readmission and return to theatre rates are significantly higher than the majority of reported series to date. The rising rate of tonsillectomy haemorrhage between cohorts is likely to be multifactorial, possibly reflecting an underestimation of previous rates, and the changing profile of the tonsillectomy patient. A detailed audit of current practice is needed to investigate these tonsillectomy outcomes, which are similar across all Health Boards in Scotland. Of most significance are the implications for accurate patient consent and non-elective ENT service provision.

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