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Safety of day-case paediatric tonsillectomy in England: an analysis of administrative data for the Getting It Right First Time programme
Anaesthesia ( IF 10.7 ) Pub Date : 2021-09-16 , DOI: 10.1111/anae.15562
W K Gray 1 , A S Takhar 2 , A V Navaratnam 1 , J Day 1 , M Swart 3 , C Snowden 4 , T W R Briggs 1 , A Marshall 5
Affiliation  

We used the Hospital Episodes Statistics database to investigate unwarranted variation in the rates Trusts discharged children the same day after scheduled tonsillectomy and associations with adverse postoperative outcomes. We included children aged 2–18 years who underwent tonsillectomy between 1 April 2014 and 31 March 2019. We stratified analyses by category of Trust, non-specialist or specialist, defined as without or with paediatric critical care facilities, respectively. We adjusted analyses for age, sex, year of surgery and aspects of presentation and procedure type. Of 101,180 children who underwent tonsillectomy at non-specialist Trusts, 62,926 (62%) were discharged the same day, compared with 24,138/48,755 (50%) at specialist Trusts. The adjusted proportion of children discharged the same day as tonsillectomy ranged from 5% to 100% at non-specialist Trusts and 9% to 88% at specialist Trusts. Same-day discharge was not independently associated with an increased rate of 30-day emergency re-admission at non-specialist Trusts but was associated with a modest rate increase at specialist Trusts; adjusted probability 8.0% vs 7.7%, odds ratio (95%CI) 1.14 (1.05–1.24). Rates of adverse postoperative outcomes were similar for Trusts that discharged >70% children the same day as tonsillectomy compared with Trusts that discharged <50% children the same day, for both non-specialist and specialist Trust categories. We found no consistent evidence that day-case tonsillectomy is associated with poorer outcomes. All Trusts, but particularly specialist centres, should explore reasons for low day-case rates and should aim for rates >70%.

中文翻译:

英格兰日间小儿扁桃体切除术的安全性:对第一次做对计划的行政数据分析

我们使用医院事件统计数据库来调查在计划的扁桃体切除术后同一天,信托基金出院率的无根据变化以及与不良术后结果的关联。我们纳入了在 2014 年 4 月 1 日至 2019 年 3 月 31 日期间接受扁桃体切除术的 2-18 岁儿童。我们按信任、非专家或专家类别对分析进行分层,分别定义为没有或有儿科重症监护设施。我们调整了年龄、性别、手术年份以及表现和手术类型方面的分析。在非专科信托机构接受扁桃体切除术的 101,180 名儿童中,有 62,926 人(62%)当天出院,而专科信托机构为 24,138/48,755 人(50%)。在扁桃体切除术当天出院的儿童的调整比例在非专科信托机构为 5% 至 100%,在专科信托机构为 9% 至 88%。当天出院与非专业信托的 30 天紧急再入院率增加无关,但与专业信托的适度增加率相关;调整后的概率 8.0% 对 7.7%,优势比 (95%CI) 1.14 (1.05–1.24)。对于非专科和专科信托类别,在扁桃体切除术当天出院> 70%儿童的信托与当天出院<50%儿童的信托的术后不良结果发生率相似。我们没有发现一致的证据表明日间扁桃体切除术与较差的结果相关。所有信托,尤其是专业中心,
更新日期:2021-09-16
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