土耳其儿童腺样体和/或扁桃体手术的实践模式与决策：一项针对耳鼻喉科医生的横断面调查

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中文摘要

目的： 儿童腺样体和扁桃体手术的实践在不同医疗体系中可能存在显著差异，尤其是在机构资源、围手术期支持和手术技术可及性不同的情况下。然而，常规实践中这种差异背后的因素仍未得到充分描述。本研究评估了土耳其耳鼻喉科（ENT）医生的手术实践模式和决策因素，特别强调机构、安全相关、技术和医疗法律决定因素。
方法： 这项全国性、描述性、横断面、基于网络的调查使用通过Google Forms分发的结构化问卷。通过专业平台邀请在土耳其积极执业的耳鼻喉科医生。调查评估了人口学特征、手术程序和技巧、手术指征、报告的并发症、机构和安全相关因素以及感知的手术频率趋势。进行了描述性统计分析。
结果： 共纳入213名耳鼻喉科医生。大多数参与者为男性（59.2%），具有≥20年的专业经验（55.4%），并在私立医疗机构工作（48.4%）。最常进行的手术是腺样体切除术联合囊外扁桃体切除术（57.3%）。67.1%的参与者偏好传统刮除术和冷钢技术，而先进技术的使用频率较低。主要指征为上气道阻塞（95.8%）和反复感染（78.4%），与指南支持的指征一致。总体而言，88.3%的参与者报告至少遇到一种围手术期或术后并发症，最常见的是继发性出血。机构准备情况、安全顾虑、围手术期支持和医疗法律问题被确定为手术决策的重要决定因素。64.8%的参与者报告手术频率感知下降。
结论： 常规实践中儿童腺样体和扁桃体手术的决策受到指南支持的临床指征以及机构准备情况、儿科围手术期支持的可及性、技术可用性、报销相关障碍和医疗法律顾虑的影响。尽管研究结果来自土耳其，但它们可能与其他在资源和支持基础设施不同的机构中进行儿童气道手术的医疗体系相关。标准化的围手术期方案和机构能力建设可能有助于减少实践差异并提高患者安全。

英文摘要

OBJECTIVE: Practices in pediatric adenoid and tonsil surgery may vary substantially across healthcare systems, especially where institutional resources, perioperative support, and access to surgical technologies differ. However, the factors underlying this variability in routine practice remain insufficiently characterized. This study evaluated surgical practice patterns and decision-making factors among otorhinolaryngology (ENT) physicians in Türkiye, with particular emphasis on institutional, safety-related, technological, and medicolegal determinants.
METHODS: This nationwide, descriptive, cross-sectional, web-based survey used a structured questionnaire distributed through Google Forms. ENT physicians actively practicing in Türkiye were invited through professional platforms. The survey assessed demographic characteristics, surgical procedures and techniques, indications for surgery, reported complications, institutional and safety-related factors, and perceived trends in surgical frequency. Descriptive statistical analyses were performed.
RESULTS: A total of 213 ENT physicians were included. Most participants were male (59.2%), had ≥ 20 years of professional experience (55.4%), and worked in private healthcare settings (48.4%). The most frequently performed procedure was adenoidectomy combined with extracapsular tonsillectomy (57.3%). Traditional curettage and cold steel techniques were preferred by 67.1% of participants, and advanced technologies were used less frequently. The predominant indications were upper airway obstruction (95.8%) and recurrent infections (78.4%), consistent with guideline-supported indications. Overall, 88.3% of participants reported encountering at least one perioperative or postoperative complication, most commonly secondary hemorrhage. Institutional readiness, safety concerns, perioperative support, and medicolegal issues were identified as important determinants of surgical decision-making. A perceived decrease in surgical frequency was reported by 64.8% of participants.
CONCLUSION: Decisions about pediatric adenoid and tonsil surgery in routine practice are shaped by guideline-supported clinical indications as well as institutional readiness, access to pediatric perioperative support, technology availability, reimbursement-related barriers, and medicolegal concerns. Although the findings originate from Türkiye, they may be relevant to other healthcare systems where pediatric airway surgery is performed in institutions with variable resources and support infrastructure. Standardized perioperative protocols and institutional capacity building may help reduce practice variability and improve patient safety.