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Patient reported pain-related outcome measures after tonsil surgery: an analysis of 32,225 children from the National Tonsil Surgery Register in Sweden 2009-2016

Journal article
Authors F. Alm
Joacim Stalfors
P. Nerfeldt
E. Ericsson
V. P. Lifornia
Published in European Archives of Oto-Rhino-Laryngology
Volume 274
Issue 10
Pages 3711-3722
ISSN 0937-4477
Publication year 2017
Published at Institute of Clinical Sciences, Department of Otorhinolaryngology
Pages 3711-3722
Language en
Keywords Children, Pain, PROM, Tonsillitis, Tonsillar hypertrophy, Tonsillectomy, Tonsillotomy, thermal welding tonsillectomy, postoperative recovery, pediatric-patients, cold dissection, morbidity, trial, adenotonsillectomy, adenoidectomy, metaanalysis, population
Subject categories Otorhinolaryngology


The objective of this study was to describe factors affecting pain after pediatric tonsil surgery, using patient reported pain-related outcome measures (pain-PROMs) from the National Tonsil Surgery Register in Sweden. In total, 32,225 tonsil surgeries on children (1 to < 18 years) during 2009-2016 were included; 13,904 tonsillectomies with or without adenoidectomy (TE +/- A), and 18,321 tonsillotomies with or without adenoidectomy (TT +/- A). Adjustments were made for variables included in the register to compensate for contributable factors in the analysis. When compared to TE +/- A for surgical indication obstruction, TT +/- A resulted in lower pain-PROMs, shorter use of postoperative analgesics, earlier return to regular food intake, and lower risk for contact with health care services due to pain. Children who underwent TE +/- A because of obstruction problems stopped taking painkillers and returned to normal eating habits sooner, compared to children who underwent TE +/- A for infectious indications. In both indication groups, TE +/- A performed with hot rather than cold technique (dissection and haemostasis) generally resulted in higher pain-PROMs. Older children reported more days on analgesics and a later return to regular food intake after TE +/- A than younger ones. No clinically relevant difference between sexes was found. Between 2012 and 2016 (pre-and post-implementation of Swedish national guidelines for pain treatment), the mean duration of postoperative analgesic use had increased. In conclusion, TE +/- A caused considerably higher ratings of pain-related outcome measures, compared to TT +/- A. For TE +/- A, cold surgical techniques (dissection and haemostasis) were superior to hot techniques in terms of pain-PROMs. Older children reported higher pain-PROMs after TE +/- A than younger ones.

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