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Increasing Readmission Rates for Hemorrhage after Tonsil Surgery: A Longitudinal (26 Years) National Study

Journal article
Authors Eirik Østvoll
O. Sunnergren
Joacim Stalfors
Published in Otolaryngology - Head and Neck Surgery
Volume 158
Issue 1
Pages 167-176
ISSN 0194-5998
Publication year 2018
Published at Institute of Clinical Sciences, Department of Otorhinolaryngology
Pages 167-176
Language en
Links https://doi.org/10.1177/01945998177...
Keywords adenotonsillectomy, postoperative hemorrhage, posttonsillectomy hemorrhage, tonsil surgery, tonsillectomy, tonsillotomy, adenoidectomy, adolescent, adult, age, Article, bleeding, child, female, gender, hemostasis, hospital readmission, human, length of stay, longitudinal study, lymphoma, major clinical study, male, preschool child, prevalence, reoperation, retrospective study, risk factor, school child, young adult
Subject categories Otorhinolaryngology

Abstract

Objective: To investigate the readmission rates due to postoperative hemorrhage in relation to tonsil surgery clinical practice in a national population. Study Design: Retrospective longitudinal population-based cohort study. Setting: Based on register data from the Swedish National Patient Register (NPR). Subjects and Methods: All benign tonsil operations (256 053) performed in Sweden from 1987 to 2013 were identified through a search in the NPR. For all identified cases, data on gender, age, date of surgery, indication, type of surgery, level of care, length of stay (LOS) for inpatient surgery, readmission and reoperation because of postoperative bleeding (within 31 days) were collected. Results: Overall frequency of readmission for hemorrhage was 2.61%, and the reoperation rate for hemostasis was 0.84%. The longitudinal analysis showed an increase from 1% (1987) to 5% (2013) in readmissions caused by hemorrhage. Tonsillectomies, surgery performed for infectious disease, and surgery on adult patients (age >18 years) showed readmission rates approaching 10% (2013). Male gender, increasing age, tonsillectomy, infectious indication, and recent year of surgery were identified as risk factors for readmission and reoperation due to hemorrhage. An increasing share of patients readmitted for hemorrhage underwent reoperation for hemostasis: 18% (1987) versus 43% (2013). Conclusion: Readmissions for hemorrhage have increased by a factor of 5 in Sweden from 1987 to 2013. The design of the study and the data in NPR do not allow determination of the true reasons behind the alarming results. © 2017, © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2017.

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