| 1. |
- 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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| 2. |
- 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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| 3. |
- 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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| 4. |
- Odhagen, Erik, 1977, et al.
(författare)
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Reducing post-tonsillectomy haemorrhage rates through a quality improvement project using a Swedish National quality register : a case study
- 2018
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Ingår i: European Archives of Oto-Rhino-Laryngology. - : Springer. - 0937-4477 .- 1434-4726. ; 275:6, s. 1631-1639
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Tidskriftsartikel (refereegranskat)abstract
- PurposeTonsillectomy (TE) is one of the most frequently performed ENT surgical procedures. Post-tonsillectomy haemorrhage (PTH) is a potentially life-threatening complication of TE. The National Tonsil Surgery Register in Sweden (NTSRS) has revealed wide variations in PTH rates among Swedish ENT centres. In 2013, the steering committee of the NTSRS, therefore, initiated a quality improvement project (QIP) to decrease the PTH incidence. The aim of the present study was to describe and evaluate the multicentre QIP initiated to decrease PTH rates.MethodsSix ENT centres, all with PTH rates above the Swedish average, participated in the 7-month quality improvement project. Each centre developed improvement plans describing the intended changes in clinical practice. The project’s primary outcome variable was the PTH rate. Process indicators, such as surgical technique, were also documented. Data from the QIP centres were compared with a control group of 15 surgical centres in Sweden with similarly high PTH rates. Data from both groups for the 12 months prior to the start of the QIP were compared with data for the 12 months after the QIP.ResultsThe QIP centres reduced the PTH rate from 12.7 to 7.1% from pre-QIP to follow-up; in the control group, the PTH rate remained unchanged. The QIP centres also exhibited positive changes in related key process indicators, i.e., increasing the use of cold techniques for dissection and haemostasis.ConclusionsThe rates of PTH can be reduced with a QIP. A national quality register can be used not only to identify areas for improvement but also to evaluate the impact of subsequent improvement efforts and thereby guide professional development and enhance patient outcomes.
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| 5. |
- Söderman, Anne-Charlotte Hessén, et al.
(författare)
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A randomized study of four different types of tympanostomy ventilation tubes - One-year follow-up
- 2016
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Ingår i: International Journal of Pediatric Otorhinolaryngology. - : Elsevier BV. - 0165-5876 .- 1872-8464. ; 89, s. 159-163
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To compare four different types of tympanostomy ventilation tubes (VT); long-shaft and short-shaft silicone tubes and long-shaft and short-shaft fluoroplastic tubes, regarding time to extrusion and events of otorrhea. Methods: A prospective randomized controlled trial in children with bilateral recurrent acute otitis media or secretory otitis media; four hundred children were randomized to receive one type of VT in the right ear and another type in the left ear. Postoperatively the children were assessed every third month by an otolaryngologist to monitor the incidence of otorrhea and tube extrusion. Results: Out of the 400 children, 22 were excluded during surgery. Mean age was 35.3 months. A majority (63.8%) were boys. Forty-eight children were lost to follow up during the first year. Significantly more short-shaft VTs were extruded after 12 months compared to long-shaft VTs, regardless of material. Significantly higher incidence of otorrhea was found in the fluoroplastic VT ears compared to the silicone ones, regardless of length of tube. Conclusion: Long-shaft VTs last longer in the eardrum during the first year of treatment. Silicone tubes render a reduced risk of otorrhea during the first year of treatment.
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| 6. |
- 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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| 7. |
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| 8. |
- 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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| 9. |
- Sunnergren, Ola, et al.
(författare)
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Nytta med tonsilloperation
- 2015
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Ingår i: Svensk ÖNH-tidskrift. - Örebro : Svensk förening för Otorhinolaryngologi, Huvud- och Halskirurgi. - 1400-0121. ; 22:S1, s. 30-32
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 10. |
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