美国威斯康星大学麦迪逊分校Ryan J. Coller团队研究了美国5个州接受扁桃体切除术儿童的患者特征与术后死亡率的关系。2022年6月21日出版的《美国医学会杂志》发表了这项成果。

儿童接受扁桃体切除术后的死亡率尚不确定。对于并发症风险增加的儿童，包括幼儿（年龄<3岁）和患有睡眠呼吸障碍或复杂慢性病的儿童，死亡率尚无法单独获取。

为了评估美国儿童扁桃体切除术后的总体死亡率以及与公认的并发症风险因素的关系，研究组基于对2005-2017年5个州的医疗成本和利用项目分发的州门诊手术、住院患者和急诊出院数据集中相关记录的纵向分析，进行了一项回顾性队列研究。参与者包括504262名小于21岁的患者，他们的出院记录可用于将门诊或住院扁桃体切除术与至少90天的随访联系起来。

暴露因素为扁桃体切除术伴或不伴腺样体切除术。主要结局为术后30天内死亡或手术时间超过30天的死亡。使用带有样本权重的修正泊松回归估计每10万次手术的术后死亡率，包括整体手术和与年龄组、睡眠呼吸障碍和复杂慢性病相关的手术。

504262名儿童共接受了505182次扁桃体切除术（患者中位年龄为7岁，女性占50.6%），其中10.1%的幼儿接受了扁桃体切除术，28.9%的儿童接受了睡眠呼吸障碍手术，2.8%的儿童接受了复杂慢性病手术。共有36例术后相关死亡，发生在手术入院后中位4.5天，其中大部分（19/36[53%]）发生在手术出院后。未校正死亡率为每10万次手术7.04例。

在多变量模型中，年龄小于3岁或睡眠呼吸障碍与死亡率均无显著相关性，但患有复杂慢性病的儿童死亡率（16例死亡/14299次手术）显著高于无这些情况的儿童（20例死亡/490883次手术），死亡率分别为每10万次手术117.22例与3.87例。患有复杂慢性疾病的儿童占扁桃体切除术的2.8%，但占术后死亡的44%。大多数与复杂慢性病相关的死亡发生在患有神经/神经肌肉或先天性/遗传疾病的儿童身上。

研究结果表明，对于接受扁桃体切除术的儿童，术后死亡率为每10万次手术7例，而患有复杂慢性病的儿童接受手术后的死亡率为每10万次手术117例。这些发现可能为儿童扁桃体切除术的决策提供信息。

附：英文原文

Title: Association of Patient Characteristics With Postoperative Mortality in Children Undergoing Tonsillectomy in 5 US States

Author: M. Bruce Edmonson, Qianqian Zhao, David O. Francis, Michelle M. Kelly, Daniel J. Sklansky, Kristin A. Shadman, Ryan J. Coller

Issue&Volume: 2022/06/21

Abstract:

Importance  The rate of postoperative death in children undergoing tonsillectomy is uncertain. Mortality rates are not separately available for children at increased risk of complications, including young children (aged <3 y) and those with sleep-disordered breathing or complex chronic conditions.

Objective  To estimate postoperative mortality following tonsillectomy in US children, both overall and in relation to recognized risk factors for complications.

Design, Setting, and Participants  Retrospective cohort study based on longitudinal analysis of linked records in state ambulatory surgery, inpatient, and emergency department discharge data sets distributed by the Healthcare Cost and Utilization Project for 5 states covering 2005 to 2017. Participants included 504262 persons younger than 21 years for whom discharge records were available to link outpatient or inpatient tonsillectomy with at least 90 days of follow-up.

Exposures  Tonsillectomy with or without adenoidectomy.

Main Outcome and Measures  Postoperative death within 30 days or during a surgical stay lasting more than 30 days. Modified Poisson regression with sample weighting was used to estimate postoperative mortality per 100000 operations, both overall and in relation to age group, sleep-disordered breathing, and complex chronic conditions.

Results  The 504262 children in the cohort underwent a total of 505182 tonsillectomies (median [IQR] patient age, 7 [4-12] years; 50.6% females), of which 10.1% were performed in young children, 28.9% in those with sleep-disordered breathing, and 2.8% in those with complex chronic conditions. There were 36 linked postoperative deaths, which occurred a median (IQR) of 4.5 (2-20.5) days after surgical admission, and most of which (19/36 [53%]) occurred after surgical discharge. The unadjusted mortality rate was 7.04 (95% CI, 4.97-9.98) deaths per 100000 operations. In multivariable models, neither age younger than 3 years nor sleep-disordered breathing was significantly associated with mortality, but children with complex chronic conditions had significantly higher mortality (16 deaths/14299 operations) than children without these conditions (20 deaths/490883 operations) (117.22 vs 3.87 deaths per 100000 operations; adjusted rate difference, 113.55 [95% CI, 51.45-175.64] deaths per 100000 operations; adjusted rate ratio, 29.39 [95% CI, 13.37-64.62]). Children with complex chronic conditions accounted for 2.8% of tonsillectomies but 44% of postoperative deaths. Most deaths associated with complex chronic conditions occurred in children with neurologic/neuromuscular or congenital/genetic disorders.

Conclusions and Relevance  Among children undergoing tonsillectomy, the rate of postoperative death was 7 per 100000 operations overall and 117 per 100000 operations among children with complex chronic conditions. These findings may inform decision-making for pediatric tonsillectomy.

DOI: 10.1001/jama.2022.8679

Source: https://jamanetwork.com/journals/jama/article-abstract/2793454