Clinical trial NCT02829515: Tonsil Surgery in Sweden: A National Quality Register
Official title: The National Tonsil Surgery Register in Sweden
Study type: OBSERVATIONAL
Overall status: UNKNOWN
Conditions: Tonsillectomy
Prospective Studies
Registries
Postoperative Complications
Lead sponsor: National Tonsil Surgery Register in Sweden
Sponsor class: OTHER
Collaborators: name: Swedish Association of Local Authorities and Regions
name: Sahlgrenska University Hospital
name: Karolinska Institutet
name: Linkoeping University
name: Region Örebro County
First posted: 2016-07-12
Enrollment: 11000
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: All patients undergoing benign tonsil surgery in Sweden

Brief summary: For the purpose of quality assurance, the Swedish Association for Otorhinolaryngology and Head and Neck surgery has developed several national registers concerning ear, nose and throat care. One of these is the National Tonsil Surgery Registry in Sweden (NTSRS). In NTSRS patients undergoing tonsil surgery for benign indications are included. Data regarding indication, surgical methods and techniques as well as patient reported outcomes measures are collected. The register is designed to facilitate description of clinical activities in a unit and help identify the need of clinical improvement programs. By compiling national data, the register can be used to describe clinical practice in a large national cohort.

Detailed description: The National Tonsil Surgery Register in Sweden (NTSRS), started in 1997 as one among several registers, aimed to reinforce quality in the Swedish health care and were revised 2009. Data in the NTSRS are collected through four questionnaires; two are filled in by the ENT-surgeon and two postoperative forms, filled in by the patient or the legal guardian, collecting patient related outcome measures (PROM) 30 respective 180 days after surgery.

In the first surgeon questionnaire age, sex, social security number and indication for surgery (upper airway obstruction, recurrent tonsillitis, chronic tonsillitis, peritonsillar abscess, and systemic complications because of tonsillitis or other) are recorded. This is filled in when surgery is notified.

The second surgeon questionnaire records surgical method (TE, TEA, TT or TTA), surgical instruments used for dissection (cold steel, radiofrequency, diathermy scissors, ultracision or other) and hemostasis method used (injection with epinephrine, unipolar diathermy, bipolar diathermy, ties, suture ligature, radiofrequency, other or "none other than compression with packs"). The questionnaire also records information regarding daycare/inpatient procedure and primary postoperative bleeding. Due to the configuration of the questionnaires and the ambition to cover both inpatient and daycare procedures, primary bleeding is defined as bleeding during hospitalization.

The first patient/caregiver form contains several questions mainly regarding postoperative complications. Any contact with healthcare provider due to postoperative bleeding/pain/infection as well as consequences of the contact; prescribed antibiotics and readmission/return to theatre are reported. Conformity between preoperative information and actual patient experience was is also included in this form.

The final questionnaire that is sent to the second patient/caregiver questionnaire asks for perceived symptom relief after 180 days by choosing one alternative of four statements: My symptoms are gone / My symptoms are almost gone / My symptoms have not disappeared/ My symptoms have worsened.

In order to assess coverage for the NTSRS, data has been matched on an individual level with another national register, the National Patient Register (NPR). The NPR is managed by the National Board of Health and Welfare and registration of surgical procedures is mandatory by law for all physicians in Sweden. The coverage of NTSRS for the study period 2012-2014 was 75%, 81.4% and 80.7% respectively

Eligibility criteria: Inclusion Criteria:

* All patients undergoing benign tonsil surgery in Sweden

Exclusion Criteria:

* All patients operated with an C- or D0-48 ICD 10 code, indicating not benign diagnoses

Primary outcomes:
measure: Patient reported symptom relief
timeFrame: 6 months postoperative report
Secondary outcomes:
measure: Patient reported postoperative bleeding
timeFrame: 30 days postoperative report
Other outcomes:
Locations:
city: Gothenburg
country: Sweden
facility: National Tonsil Surgery Register in Sweden
Study officials:
affiliation: Sahlgrenska Academy
name: Joacim Stalfors, MD, PhD
role: STUDY_DIRECTOR
References:
citation: Odhagen E, Sunnergren O, Hemlin C, Hessen Soderman AC, Ericsson E, Stalfors J. Risk of reoperation after tonsillotomy versus tonsillectomy: a population-based cohort study. Eur Arch Otorhinolaryngol. 2016 Oct;273(10):3263-8. doi: 10.1007/s00405-015-3871-7. Epub 2016 Jan 4.
citation: Gerhardsson H, Stalfors J, Odhagen E, Sunnergren O. Pediatric adenoid surgery in Sweden 2004-2013: Incidence, indications and concomitant surgical procedures. Int J Pediatr Otorhinolaryngol. 2016 Aug;87:61-6. doi: 10.1016/j.ijporl.2016.05.020. Epub 2016 May 20.
citation: Ostvoll E, Sunnergren O, Ericsson E, Hemlin C, Hultcrantz E, Odhagen E, Stalfors J. Mortality after tonsil surgery, a population study, covering eight years and 82,527 operations in Sweden. Eur Arch Otorhinolaryngol. 2015 Mar;272(3):737-43. doi: 10.1007/s00405-014-3312-z. Epub 2014 Oct 2.
citation: Ostvoll E, Sunnergren O, Stalfors J. Increasing Readmission Rates for Hemorrhage after Tonsil Surgery: A Longitudinal (26 Years) National Study. Otolaryngol Head Neck Surg. 2018 Jan;158(1):167-176. doi: 10.1177/0194599817725680. Epub 2017 Aug 22.
citation: Sunnergren O, Odhagen E, Stalfors J. Incidence of second surgery following pediatric adenotonsillar surgery: a population-based cohort study. Eur Arch Otorhinolaryngol. 2017 Jul;274(7):2945-2951. doi: 10.1007/s00405-017-4543-6. Epub 2017 Mar 23.
citation: Borgstrom A, Nerfeldt P, Friberg D, Sunnergren O, Stalfors J. Trends and changes in paediatric tonsil surgery in Sweden 1987-2013: a population-based cohort study. BMJ Open. 2017 Jan 13;7(1):e013346. doi: 10.1136/bmjopen-2016-013346.
citation: Elinder K, Soderman AC, Stalfors J, Knutsson J. Factors influencing morbidity after paediatric tonsillectomy: a study of 18,712 patients in the National Tonsil Surgery Register in Sweden. Eur Arch Otorhinolaryngol. 2016 Aug;273(8):2249-56. doi: 10.1007/s00405-016-4001-x. Epub 2016 Mar 28.
citation: Soderman AC, Odhagen E, Ericsson E, Hemlin C, Hultcrantz E, Sunnergren O, Stalfors J. Post-tonsillectomy haemorrhage rates are related to technique for dissection and for haemostasis. An analysis of 15734 patients in the National Tonsil Surgery Register in Sweden. Clin Otolaryngol. 2015 Jun;40(3):248-54. doi: 10.1111/coa.12361.
citation: Sunnergren O, Hemlin C, Ericsson E, Hessen-Soderman AC, Hultcrantz E, Odhagen E, Stalfors J. Radiofrequency tonsillotomy in Sweden 2009-2012. Eur Arch Otorhinolaryngol. 2014 Jun;271(6):1823-7. doi: 10.1007/s00405-013-2867-4. Epub 2013 Dec 24.
citation: Hultcrantz E, Ericsson E, Hemlin C, Hessen-Soderman AC, Roos K, Sunnergren O, Stalfors J. Paradigm shift in Sweden from tonsillectomy to tonsillotomy for children with upper airway obstructive symptoms due to tonsillar hypertrophy. Eur Arch Otorhinolaryngol. 2013 Sep;270(9):2531-6. doi: 10.1007/s00405-013-2374-7. Epub 2013 Feb 6.
citation: Stalfors J, Ericsson E, Hemlin C, Hultcrantz E, Mansson I, Roos K, Hessen Soderman AC. Tonsil surgery efficiently relieves symptoms: analysis of 54 696 patients in the National Tonsil Surgery Register in Sweden. Acta Otolaryngol. 2012 May;132(5):533-9. doi: 10.3109/00016489.2011.644252. Epub 2012 Jan 11.
citation: Hessen Soderman AC, Ericsson E, Hemlin C, Hultcrantz E, Mansson I, Roos K, Stalfors J. Reduced risk of primary postoperative hemorrhage after tonsil surgery in Sweden: results from the National Tonsil Surgery Register in Sweden covering more than 10 years and 54,696 operations. Laryngoscope. 2011 Nov;121(11):2322-6. doi: 10.1002/lary.22179. Epub 2011 Oct 12.
citation: Odhagen E, Sunnergren O, Soderman AH, Thor J, Stalfors J. Reducing post-tonsillectomy haemorrhage rates through a quality improvement project using a Swedish National quality register: a case study. Eur Arch Otorhinolaryngol. 2018 Jun;275(6):1631-1639. doi: 10.1007/s00405-018-4942-3. Epub 2018 Mar 24.
citation: Alm F, Stalfors J, Nerfeldt P, Ericsson E. Patient reported pain-related outcome measures after tonsil surgery: an analysis of 32,225 children from the National Tonsil Surgery Register in Sweden 2009-2016. Eur Arch Otorhinolaryngol. 2017 Oct;274(10):3711-3722. doi: 10.1007/s00405-017-4679-4. Epub 2017 Aug 16.
citation: Hallenstal N, Sunnergren O, Ericsson E, Hemlin C, Hessen Soderman AC, Nerfeldt P, Odhagen E, Ryding M, Stalfors J. Tonsil surgery in Sweden 2013-2015. Indications, surgical methods and patient-reported outcomes from the National Tonsil Surgery Register. Acta Otolaryngol. 2017 Oct;137(10):1096-1103. doi: 10.1080/00016489.2017.1327122. Epub 2017 Jun 9.
citation: Gudnadottir G, Tennvall GR, Stalfors J, Hellgren J. Indirect costs related to caregivers' absence from work after paediatric tonsil surgery. Eur Arch Otorhinolaryngol. 2017 Jun;274(6):2629-2636. doi: 10.1007/s00405-017-4526-7. Epub 2017 Mar 14.