丹麦扁桃体手术后高出血率及质量改进机会
High Bleeding Rates After Tonsil Surgery in Denmark and Opportunities for Quality Improvement.
文献信息
| PMID | 42893798 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Martin Mølhave |
| 作者单位 | Department of Otorhinolaryngology, Head & Neck Surgery, Gødstrup Hospital, University Clinic for Flavour, Balance and Sleep, Herning, Denmark. |
| 期刊 | Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery |
| SCI 分区 | Q2 |
| IF | 2 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的： 考察丹麦扁桃体手术后的术后出血率及相关患者与手术因素，并确定质量改进的目标。
设计： 采用前瞻性收集的登记数据进行的多中心队列研究。
地点： 2018-2024年向丹麦扁桃体数据库贡献数据的五个丹麦耳鼻咽喉科。
参与者： 因良性适应证接受扁桃体切除术、腺样体扁桃体切除术、扁桃体部分切除术、腺样体扁桃体部分切除术或急性扁桃体切除术的儿童、青少年和成人。
主要结局指标： 30天内临床确认的术后出血。采用稳健标准误的改良泊松回归估计校正相对危险度（RR）。
结果： 在6145例手术中，扁桃体切除术后出血发生率为14%，腺样体扁桃体切除术为9.9%，急性扁桃体切除术为10%，扁桃体部分切除术为1.7%，腺样体扁桃体部分切除术为2.6%。在出血事件中，51%需要全身麻醉，32%需要局部麻醉，17%自行缓解。扁桃体切除术后，男性（校正RR 1.69，95% CI 1.44-2.00）和住院医师手术（校正RR 1.25，95% CI 1.04-1.51）与更高风险相关，而年龄<12岁（校正RR 0.53，95% CI 0.37-0.74）和12-17岁（校正RR 0.57，95% CI 0.43-0.76）的患者风险低于成人。冷分离联合冷止血的扁桃体切除术粗出血率最低（9.8%），但校正后手术技术与出血无独立关联。无死亡发生。
结论： 扁桃体切除术后的出血率高于若干国际队列报告的水平，而扁桃体部分切除术后的出血率较低。冷分离联合冷止血的扁桃体切除术观察到的出血率最低，尽管校正分析无统计学显著性。这些发现支持开展结构化的质量改进工作和持续监测。
英文摘要
OBJECTIVES: To examine postoperative bleeding rates and associated patient and surgical factors after tonsil surgery in Denmark and identify targets for quality improvement.
DESIGN: Multicentre cohort study using prospectively collected registry data.
SETTING: Five Danish ENT departments contributing to the Danish Tonsil Database, 2018-2024.
PARTICIPANTS: Children, adolescents and adults undergoing tonsillectomy, adenotonsillectomy, tonsillotomy, adenotonsillotomy or acute tonsillectomy for benign indications.
MAIN OUTCOME MEASURES: Clinically confirmed postoperative bleeding within 30 days. Modified Poisson regression with robust standard errors estimated adjusted relative risks (RRs).
RESULTS: Among 6145 procedures, postoperative bleeding occurred after 14% of tonsillectomies, 9.9% of adenotonsillectomies, 10% of acute tonsillectomies, 1.7% of tonsillotomies and 2.6% of adenotonsillotomies. Among bleeding events, 51% required general anaesthesia, 32% local anaesthesia and 17% resolved spontaneously. After tonsillectomy, male sex (adjusted RR 1.69, 95% CI 1.44-2.00) and resident surgery (adjusted RR 1.25, 95% CI 1.04-1.51) were associated with higher risk, while patients aged < 12 years (adjusted RR 0.53, 95% CI 0.37-0.74) and 12-17 years (adjusted RR 0.57, 95% CI 0.43-0.76) had lower risk than adults. Cold dissection with cold haemostasis tonsillectomy had the lowest crude bleeding rate (9.8%), but operative technique was not independently associated with bleeding after adjustment. No deaths occurred.
CONCLUSIONS: Bleeding rates after tonsillectomy were higher than those reported in several international cohorts, while rates after tonsillotomy were low. Cold dissection with cold haemostasis tonsillectomy had the lowest observed rate, although adjusted analyses were not statistically significant. These findings support structured quality-improvement work and continued monitoring.