Abstract

PurposeTonsillectomy (TE) is one of the most frequently performed ENT surgical procedures. Post-tonsillectomy haemorrhage (PTH) is a potentially life-threatening complication of TE. The National Tonsil Surgery Register in Sweden (NTSRS) has revealed wide variations in PTH rates among Swedish ENT centres. In 2013, the steering committee of the NTSRS, therefore, initiated a quality improvement project (QIP) to decrease the PTH incidence. The aim of the present study was to describe and evaluate the multicentre QIP initiated to decrease PTH rates.MethodsSix ENT centres, all with PTH rates above the Swedish average, participated in the 7-month quality improvement project. Each centre developed improvement plans describing the intended changes in clinical practice. The project’s primary outcome variable was the PTH rate. Process indicators, such as surgical technique, were also documented. Data from the QIP centres were compared with a control group of 15 surgical centres in Sweden with similarly high PTH rates. Data from both groups for the 12 months prior to the start of the QIP were compared with data for the 12 months after the QIP.ResultsThe QIP centres reduced the PTH rate from 12.7 to 7.1% from pre-QIP to follow-up; in the control group, the PTH rate remained unchanged. The QIP centres also exhibited positive changes in related key process indicators, i.e., increasing the use of cold techniques for dissection and haemostasis.ConclusionsThe rates of PTH can be reduced with a QIP. A national quality register can be used not only to identify areas for improvement but also to evaluate the impact of subsequent improvement efforts and thereby guide professional development and enhance patient outcomes.

Highlights

  • Tonsillectomy (TE) is one of the most frequently performed ENT surgical procedures, with over 700,000 operations performed in the United States each year [1]

  • One centre that used coblation prior to the quality improvement project (QIP) changed to cold dissection during the intervention period

  • All the centres aimed to upgrade the surgical status of tonsillectomy

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Summary

Introduction

Tonsillectomy (TE) is one of the most frequently performed ENT surgical procedures, with over 700,000 operations performed in the United States each year [1]. There are two main indications for tonsil surgery: (1) upper airway obstruction in children resulting in sleep-disordered breathing, and (2) infection-related problems (recurrent tonsillitis, chronic tonsillitis or peritonsillar abscess) [3]. Patients undergoing tonsil surgery due to upper airway obstruction are typically younger (incidence peaks at ages 3–5 years) and predominantly male; in contrast, patients undergoing tonsil surgery because of. Reported rates of PTH vary in the literature; recent large studies indicate a range between 6 and 15% [5,6,7,8]. Fatal outcomes after PTH are rare, but should not be overlooked: a large Swedish cohort study documented a mortality rate after tonsil surgery (including both total and partial TE) of 1/40,000 [9]. The rate of PTH is of one the most important quality and safety indicators in tonsil surgery

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