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Does tonsillectomy reduce medical care visits for pharyngitis/tonsillitis in children and adults? Retrospective cohort study from Sweden

Artikel i vetenskaplig tidskrift
Författare Eirik Østvoll
O. Sunnergren
Joacim Stalfors
Publicerad i BMJ Open
Volym 9
Nummer/häfte 11
ISSN 2044-6055
Publiceringsår 2019
Publicerad vid Institutionen för kliniska vetenskaper, Avdelningen för öron-, näs- och halssjukdomar
Språk en
Länkar dx.doi.org/10.1136/bmjopen-2019-033...
Ämnesord ambulatory care, pharyngitis, tonsillectomy, tonsillitis, adenotonsillectomy, adolescent, adult, Article, child, cohort analysis, controlled study, female, groups by age, human, infant, major clinical study, male, medical care, newborn, outcome assessment, pediatric patient, register, retrospective study, Sweden
Ämneskategorier Oto-rino-laryngologi

Sammanfattning

Objective To assess the effectiveness of tonsillectomy/adenotonsillectomy in reducing medical care visits for pharyngitis or tonsillitis in children and adults with chronic/recurrent tonsillitis. Design Retrospective cohort study. Setting Data were retrieved from the VEGA register, a comprehensive regional cohort in Sweden. Participants 1044 children (<15 years) and 2244 adults. Intervention Tonsillectomy/adenotonsillectomy compared with no surgical treatment. Main outcome measures Changes in yearly mean rates of medical care visits due to pharyngitis/tonsillitis. Results In children, there was a significant decrease in the yearly mean medical care visits rate from 1.93 (1.82 to 2.04) before surgery to 0.129 (0.099 to 0.165) after surgery, with a mean change of -1.80 (-1.90 to -1.69), p<0.0001. In patients who did not undergo surgery, the corresponding mean change was -1.51 (-1.61 to -1.41), resulting in a mean difference in the change in visit rates between the intervention and control groups of -0.283 (-0.436 to -0.135), p=0.0002. In adults, a significant decrease in the yearly mean medical care visit rate was observed from 1.45 (1.39 to 1.51) before surgery to 0.152 (0.132 to 0.173) after surgery, with a mean change of -1.30 (-1.36 to -1.24), p<0.0001, compared with -1.18 (-1.24 to -1.13) in the control group. The difference in the change in yearly mean visit rate between the surgical and non-surgical groups was -0.111 (-0.195 to -0.028), p=0.0097. The subgroup analysis showed a greater effect of surgery in children, in patients with a higher number of medical care visits before surgery and in the first year of follow-up. Conclusion In this cohort of patients moderately or less affected with chronic/recurrent tonsillitis, the effectiveness of tonsillectomy/adenotonsillectomy in reducing medical care visits for pharyngitis and tonsillitis compared with no surgical treatment was low and of questionable clinical value. © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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