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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
Links doi.org/10.1007/s00405-017-4679-4
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

Abstract

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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