| 1. |
- Ericsson, Elisabeth, 1959-, et al.
(författare)
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The role of information and instruction to children and parents in homemanagement after tonsil surgery - what is it helpful for them to know?
- 2010
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Konferensbidrag (refereegranskat)abstract
- OBJECTIVES To create national recommendations for information after tonsil surgery to improve the management ofchildren. METHODS 1. A search of Medline addressing evidence on expectations and advice about medication and nonpharamacological techniques to relieve pain after tonsil surgery and 2. A questionnaire focusing on the routines for information before and after tonsil surgery was administrated to all ENT-clinics in Sweden with 99% response rate. RESULTS There is evidence that information has an empowering effect upon parents to feel more control over their child’s care. Lack of information leads to anxiety and increased perception of pain in the child. Children and parents who were given specific information related to pain and morbidity, reported less pain and were less anxious than those with no or insufficient information. Constructive information should be given gradually, starting preoperatively, to parents and children. A leaflet should contain sufficient information about what happens before, during and is to be expected after surgery, the risks and possible complications, and advice and recommendation of medication and non-pharmacological techniques. Results from the national enquiry (N=48) showed the provision of a variety of different written information from the various clinics, often insufficient. Based on these findings, an information leaflet for patients and a checklist based on the literature for the staff to use at discharge were developed (both will be available). CONCLUSIONS A checklist for the staff insures that parents and children get consistent advice. A leaflet provided before surgery helps children and parents with methods to relieve pain. This could decrease the number of complications and later consultations and give shorter recovery.
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| 2. |
- Alm, Fredrik, 1983-, et al.
(författare)
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Adherence to Swedish Guidelines for Pain Treatment in Tonsil Surgery in Pediatric Patients
- 2016
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Konferensbidrag (refereegranskat)abstract
- Objective: As shown by data from the National Tonsil Surgery Register in Sweden, tonsil surgery often causes severe pain that lasts for many days. The register data demonstrate the necessity for better evidence-based pain treatment guidelines for tonsil surgery. The guidelines, introduced in 2013, consist of both pharmacological and non-pharmacological recommendations. In the guidelines, a multimodal analgesic approach and combination of analgesics are recommended to provide effective pain treatment with limited side effects. Two national multi-professional education days on pain, pharmacology and the guidelines were offered. Web-based information about pharmacological treatment (www.tonsililloperation.se) was designed for patients and next-of-kin. The current aims were to describe adherence to the Swedish guidelines for pain treatment in tonsil surgery in pediatric patients < 18 yearsMethod: An inter-professional questionnaire was developed, including questions linked to the relevant guidelines. The questions came from a national mapping before the guidelines were designed. The items were discussed by an expert group, and content validity was evaluated using the content validity index.ENT-and anesthesia physicians and nurses from all 50 ENT clinics in Sweden were enrolled.Results: Most clinics had received the guidelines, but there was a discrepancy between the professions. More than half had perused the literature review performed before the guidelines were designed, and attended themulti-professional education day. Pre- and perioperative treatment usually included paracetamol, clonidine and betamethasone. A multimodal pain approach after discharge from hospital (tonsillectomy and tonsillotomy) was used, combining paracetamol with cox-inhibitors. Most clinics used paracetamol, with a higher dose for the first 3 days (healthy children and acceptable nutrition), and a reduced dose from day 4.In case of inadequate analgesia after tonsillectomy, oral clonidine or opioids were used. Several clinics followed the recommendation to use clonidine as first choice and secondly an opioid. No respondents prescribed codeine compared to 80% at the mapping before the guidelines were designed. The guidelines were experienced as clear, safe and sufficient. The web-based information was used by most of the clinics to improve quality of care and provide facilitating tools for patients, relatives and caregivers.Conclusion: Swedish guidelines for tonsil surgery provide practical evidence-based pain treatment recommendations. To achieve a change, multi-professional education is necessary. This needs to be repeated for a wider spread.Future research should include evaluation through pain diaries and questionnaires to next-of-kin and children. There should be matching of data from the quality registers at each clinic, with pain variables such as unplanned health care contacts due to pain, number of days with analgesics, and return to normal diet
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| 3. |
- Hessen-Söderman, Anne-Charlotte, et al.
(författare)
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Blödning efter tonsilloperation : Resultat ur nya nationella kvalitetsregistret
- 2009
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Bakgrund: Det nya kvalitetsregistret för tonsilloperation startade 090301. Uppgifter angående operationsmetod och använd utrustning registreras nu samt om mer än en operationsindikation har använts. Nytt är en postop. 30-dagarsenkät som föräldrarna/vuxna patienter får besvara via nätet. Då får man besked angående det postoperativa förloppet inkl. sekundära blödningar.Resultat: Fem månader efter start har 2341 patienter registrerats varav 2020 är opererade. 1109 har besvarat 30-dagarsenkäten och ännu ingen 6- månaders-formuläret. Det vanligaste ingreppet är Tonsillektomi (TE) med 976 operationer följt av tonsillotomi (TT)+Abrasio, 495 ingrepp, därefter TE+Abrasio 413 och TT 104. Primär blödning är ungefär lika vanligt för de tre första ingreppen, 2,6%, 1,8% resp. 2,4% och enbart TT 0%.Sekundär blödning, som rapporterats av föräldrarna/patienten efter 30 dagar visar TE 9%, TE+Abrasio 2,6% , TT 2% och TT + Abrasio 0.7%. Av metoder har kallt stål använts flitigast: 1078 operationer med 2,7% primära blödningar och 6% sekundära, följt av Radiofrekvens, 684 operationer med 1,5% primära och 1,6% sekundära blödningar. Diatermisax har använts på 131 patienter med 1,5% primära och 22% sekundärblödningar, Ultracision vid 79 operationer med 0 primär och 7,7% sekundärblödning samt Laser vid 22 operationer med 1,5% primär och 9% sekundärblödning.Diskussion: De olika prevalenser av postoperative blödning som resultaten visar är inte entydiga: Enbart TE görs nästan enbart på vuxna, oftast på infektionsindikation, vilket kan förklara en högre blödningsförekomst jämfört med TE+Abrasio, som istället enbart görs på barn med obstruktionsindikation, med mindre blödning som följd. Skillnaden i blödning, mellan TE och TT är dock klar, eftersom relativt många individer är opererade i båda grupperna och man genomgående har signifikant lägre blödning för TT. När det gäller operationsmetod visar de ”heta” metoderna lägre primärblödning men fler sekundär-blödningar än kallt stål. Radiofrekvens, som arbetar vid lägre temperatur har de lägsta blödningstalen både vad gäller primär- och sekundärblödning. En bias är att enbart hälften av de opererade har skickat in 30-dagarsenkät. De minst nöjda, dvs. de som blött efteråt, är kanske mer villiga att påtala detta, vilket i så fall generellt ger för höga blödningstal. Konklusion: TT ger färre primära och sekundära blödningar än TE. ”Heta” tekniker ger ett stort antal sekundära blödningar. Högre svarsfrekvens eftersträvas.
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| 4. |
- Hessén-Söderman, Anne-Charlotte, et al.
(författare)
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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
- 2015
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Ingår i: Clinical Otolaryngology. - : Wiley. - 1749-4478 .- 1365-2273. ; 40:3, s. 248-254
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To analyse post-tonsillectomy haemorrhage(PTH) rates related to technique for dissection and haemostasis.Study Design: Register study from the National TonsilSurgery Register in Sweden (NTSRS).Methods: All patients, subjected to tonsillectomy (TE)without adenoidectomy from 1 March 2009 to 26 April 2013,were included in the study. The surgeon reports data abouttechnique and early PTH, while late PTH is reported by thepatient in a questionnaire 30 days after surgery.Results: 15734 patients with complete data concerningtechnique for dissec tion and for haemostasis were identifiedin the NTSRS. Techniques used were cold steel dissectionwith uni- or bipolar diathermy haemostasis (65.3%),diathermy scissors (15.7%), coblation (9.1%), cold steeldissection with cold haemostasis (7.4%) and ultrascision(2.5%). Early and late PTH were reported in 3.2% and 9.4% of the cases, respectively, and return to theatre (RTT) in2.7%. The rat es for PTH and RTT related to technique wereanalysed. Compared with cold dissection+ cold haemostasis,late PTH rate was 2.8 times higher after cold dissection + hothaemostasis, 3.2 times higher after coblation, 4.3 timeshigher after diathermy scissors and 5.6 times higher afterultrascision. The risk for RTT was higher for all hottechniques except for coblation, while ultrascision resultedin a lower risk for early PTH.Conclusions: All hot techniques resulted in a higher risk forlate PTH compared with cold steel dissection +coldhaemostasis. The risk for RTT was higher for all hottechniques except for coblation, while ultrascision resultedin a lower risk for early PTH. An early PTH was associatedwith an increased risk for late PTH.
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| 5. |
- Hultcrantz, Elisabeth, et al.
(författare)
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Tonsillectomy or Tonsillotomy : Is a change of paradigm on-going? Data out of a new National Tonsil Surgery Register in Sweden
- 2010
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Konferensbidrag (refereegranskat)abstract
- OBJECTIVESTo study the current prevalence of different tonsil surgery techniques in children with obstructive symptoms in Sweden and the rates of primary and secondary bleeding as a function of the procedure and technique used.METHODSThe new National Tonsil Surgery Register in Sweden was used; this registry was opened in March 2009.The data for patients aged 1–15 years operated for obstruction was analyzed. To the registry, age, sex,indication for surgery, surgical procedure and techniques is recorded prospectively, as is primary bleedings occurring during hospital stay. 30 days after surgery, complications such as secondary bleedings,uncontrolled pain and nosocomial infections are reported by parents in questionnaires collected using asecure internet-page.RESULTSA total of 3980 patients between 1–15 years were operated during the period covered, of whom 3172 for obstructive symptoms. Of the 1876 that have thus far answered the 30 day post-operative questionnaire 511 were operated with adenotonsillectomy (A+TE) and 943 with adenotonsillotomy (A+TT), 246 were operated with tonsillectomy (TE) and 174 with tonsillotomy (TT). Primary bleedings were reported in 55/3172 patients: 2.4% after A+TE, 1.8% after A+TT, 1.9% after TE and 0.35% after TT. Secondary bleedings were noted in 36/1876 patients: 3.3% after A+TE, 0.85% after A+TT, 4.1% after TE and 0.6% after TT. The used surgical techniques (TE/TT) were cold steel (455/17), radiofrequency (72/864), diathermy (39/2), ultracision (23/24) or laser (3/22).CONCLUSIONSTT for the indication, “obstruction” has become more common than TE. TT results in fewer both primary and secondary postoperative bleedings. Further analyzes
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| 6. |
- Odhagen, Erik, 1977, et al.
(författare)
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Long-term complications after tonsil surgery : an analysis of 54,462 patients from the Swedish Quality Register for Tonsil Surgery
- 2023
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Ingår i: Frontiers in Surgery. - : Frontiers Media S.A.. - 2296-875X. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Objective: This study aims to evaluate long-term complications after tonsil surgery using an exploratory retrospective cohort study design based on data from the Swedish Quality Register for Tonsil Surgery (SQTS).Methods: All patients registered in the SQTS between 1 January 2009 and 31 May 2021 were eligible for the study. In this study, a long-term complication is defined as any complication persisting for a minimum of 6 months after surgery. The definition of a complication was based on individual patient reports, provided in a free text format, of any remaining issues 6 months after tonsil surgery. Complications were categorized as follows: disturbed taste or sense of smell, dysphagia, miscellaneous and general symptoms and signs, miscellaneous throat problems, pain or discomfort in the mouth or throat, problems with jaws or teeth, problems with the ears or hearing, problems with the nose or sinuses, problems with throat secretions or throat clearing, problems with voice or speech, and sensory symptoms. A multivariable logistic regression analysis was used to identify independent predictors of long-term complications.Results: In total, 54,462 patients were included in the study. A total of 3,780 patients (6.9%) reported one or more long-term complications. The most frequent long-term complications, with a plausible connection to the surgery, were found in the following categories: pain or discomfort in the mouth or throat (1.9%), problems with throat secretions or throat clearing (0.8%), dysphagia (0.6%), and problems with voice or speech (0.6%). Tonsillotomy was associated with a lower risk of long-term complications than tonsillectomy.Conclusion: This study suggests that subjective long-term complications after tonsil surgery, in general, are relatively common (6.9%). However, complications with a plausible connection to the surgery were less common (4.0%), and specific complications seemed to be relatively rare, with no single specific problem reaching a prevalence of ≥0.6%.
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| 7. |
- Lundström, Filip, 1984-, et al.
(författare)
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A validation study of data in the National Tonsil Surgery Register in Sweden : high agreement with medical records ensures that data can be used to monitor clinical practices and outcomes
- 2022
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Ingår i: BMC Medical Research Methodology. - : BioMed Central. - 1471-2288. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The ambition of the National Tonsil Surgery Register in Sweden (NTSRS) is to improve otorhinolaryngological care by monitoring trends in the clinical practices, complications, and outcomes of tonsil surgery. The NTSRS collects data from both surgeons and patients and provides the participating clinics with daily updated data on a publicly available website. On the website, national and local results can be compared and monitored. The use of NTSRS data necessitates that the data is valid, but the NTSRS has not yet been validated. With approximately half of the registered patients responding to the postoperative questionnaires, an analysis of responders and non-responders is also necessary. The aim of this study was to assess the criterion validity of NTSRS data. Another aim was to compare the characteristics and rates of complications between postoperative questionnaire responders and non-responders.Methods: Data in the NTSRS were compared with data in electronic medical records. The 200 most recent surger-ies, up to 31 Dec 2019, in each of 11 surgical units were included. Criterion validity was analysed in terms of observed agreement, Cohens kappa, Gwet’s AC1, and positive and negative agreement. The sign test was used to analyse systematic differences between the NTSRS and the medical records. Comparisons of rates between groups were made with Fisher’s exact test, the chi-square test, and Fisher’s non-parametric permutation test.Results: A total of 1991 registrations were included in the study. All variables showed very high observed agreement ranging from 0.91 to 1.00, and all variables had AC1 values corresponding to almost perfect agreement. The analysis of questionnaire responders and non-responders showed no statistically significant differences regarding age, indication, or type of surgery. The proportion of women was higher in the responder group. The rate of reoperation due to bleeding was higher in the responder group, but there were no differences regarding other complications.Conclusions: The results of this study show that data in the NTSRS have criterion validity. The NTSRS is thus well suited for monitoring the clinical practices and outcomes of tonsil surgery. The quality of the data also implies that the registry can be used in both clinical improvement projects and research.
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| 8. |
- Stalfors, Joacim, et al.
(författare)
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Registerdata från tonsillregistret
- 2015
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Ingår i: Svensk ÖNH-tidskrift. - Örebro : Svensk förening för Otorhinolaryngologi, Huvud- och Halskirurgi. - 1400-0121. ; 22:3, s. 34-93
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Tidskriftsartikel (populärvet., debatt m.m.)
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| 9. |
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| 10. |
- Stalfors, Joacim, 1966, et al.
(författare)
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Tonsil surgery efficiently relieves symptoms, Analysis of 54 696 paqtients in The National Tonsil Surgery Register in Sweden
- 2012
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Ingår i: Acta Oto-Laryngologica. - London, United Kingdom : Informa UK Limited. - 0001-6489 .- 1651-2251. ; 132:5, s. 533-539
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Tidskriftsartikel (refereegranskat)abstract
- CONCLUSION:Patients operated with tonsillar surgery report a high degree of symptom relief 6 months after surgery.OBJECTIVE:The purpose of this study was to analyze symptom relief 6 months after tonsil surgery in relation to age, indication, surgical procedure, primary bleeding and unplanned postoperative visits. The National Tonsil Surgery Register in Sweden offers data from 54,696 patients registered during 1997-2008.METHODS:This was a prospective assessment by questionnaire. Data were collected using three questionnaires, two completed by professionals and one 6 months postoperatively by the parents/patients.RESULTS:Among 54,696 patients, the most common surgical indications were obstruction (49.7%), followed by recurrent tonsillitis (35.2%). Symptom relief 6 months after surgery was high in all indication groups (>92%), and highest for patients operated on the indication peritonsillitis (>98%). The indications obstruction, recurrent tonsillitis or chronic tonsillitis reported a high degree (>96%) of symptom relief. Of the patients who underwent tonsillectomy with adenoidectomy, 97.5% were symptom-free compared to 96% of patients who had tonsillectomy alone and 96.1% who underwent tonsillotomy (p < 0.0001). In all, 13.9% of patients required an unplanned visit to the clinic postoperatively. Only 148 of 54,696 patients reported worsening of symptoms after surgery.
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