Background
Methods
The Norwegian tonsil surgery register
Variable | Definition |
---|---|
Date of birth Date of surgery | |
Indication of surgery | |
Airway obstruction/snoring/hypertrophic tonsils | Tonsils cause breathing disorder during sleep (parent reported) |
Recurrent tonsillitis | At least three episodes of acute tonsillitis during last 12 months |
Peritonsillar abscess | Peritonsillar abscess or peritonsillitis warranting emergency operation, or history of peritonsillar abscesses/peritonsillitis |
Chronic tonsillitis | Prolonged inflammation of the tonsils (at least 3 months) affecting daily activities |
Other | Free field to register other indications |
Surgical Unit | |
Day case surgery | No admission overnight |
Overnight surgery | Prearranged overnight admission |
Type of surgery | |
Primary surgery | No previous tonsil surgery performed |
Revision surgery | Tonsillectomy or tonsillotomy performed previously |
Extent of surgery | |
Tonsillectomy only | Extracapsular removal of tonsils |
Tonsillectomy and adenoidectomy | Extracapsular removal of tonsils and removal of adenoid |
Tonsillotomy only | Partial removal of tonsils |
Tonsillotomy and adenoidectomy | Partial removal of tonsils and removal of adenoid |
Surgical technique | |
Cold steel | Procedure performed with cold instruments only, for example knife, scissors or elevator |
Radiofrequency | Radiofrequency energy is used for cutting and coagulation |
Diathermy scissors | Procedure performed with bipolar diathermy scissors, which can simultaneously cut and coagulate |
Ultracision | Procedure performed with instrument, which simultaneously cuts and coagulates using ultrasonic vibration |
Dissection with bipolar diathermy | Tonsils are dissected using bipolar diathermy |
Other | Free field to register other techniques |
Technique for haemostasis | |
Infiltration with local anaesthetic and adrenalin | Haemostasis achieved with adrenaline vasopressor effect |
Monopolar diathermy | Heat coagulation of the vessels using monopolar diathermy |
Bipolar diathermy | Heat coagulation of the vessels using bipolar diathermy |
Ligature | Suture used to stop haemorrhage |
Suture ligature | Suture with needle used to stop haemorrhage |
Radiofrequency | Haemostasis achieved using radiofrequency instruments |
None | Haemostasis achieved with compression only |
Other | Free field to register other techniques |
Primary haemorrhage requiring intervention (Yes/No) | Any haemorrhage requiring intervention and occurring after extubation during initial hospital stay |
Data collection
Statistical analysis
Yes (medical records) | Yes (register) | No (medical records) | No (register) | |
---|---|---|---|---|
Indication of surgery | ||||
Airway obstruction/snoring/hypertrophic tonsils | 74 | 73 | 63 | 64 |
Recurrent tonsillitis | 39 | 33 | 98 | 104 |
Peritonsillar abscess | 4 | 4 | 133 | 133 |
Chronic tonsillitis | 19 | 23 | 118 | 114 |
Other | 1 | 1 | 136 | 136 |
Surgical Unit | ||||
Day case surgery | 86 | 91 | 51 | 46 |
Overnight surgery | 51 | 46 | 86 | 91 |
Primary surgery or revision surgery | ||||
Primary surgery | 134 | 134 | 3 | 3 |
Revision surgery | 3 | 3 | 134 | 134 |
Extent of surgery | ||||
Tonsillectomy only | 57 | 56 | 80 | 81 |
Tonsillectomy and adenoidectomy | 27 | 27 | 110 | 110 |
Tonsillotomy only | 9 | 13 | 128 | 124 |
Tonsillotomy and adenoidectomy | 44 | 41 | 93 | 96 |
Surgical technique | ||||
Cold steel | 29 | 38 | 108 | 99 |
Radiofrequency | 0 | 0 | 0 | 0 |
Diathermy scissors | 107 | 105 | 30 | 32 |
Ultracision | 0 | 3 | 137 | 134 |
Laser | 0 | 0 | 0 | 0 |
Dissection with bipolar diathermy | 2 | 1 | 135 | 136 |
Other technique | 0 | 0 | 0 | 0 |
Technique for haemostasis | ||||
Haemostasis achieved with compression only | 12 | 10 | 125 | 127 |
Infiltration with local anaesthetic and adrenalin | 5 | 6 | 132 | 131 |
Monopolar diathermy | 0 | 2 | 137 | 135 |
Bipolar diathermy | 124 | 124 | 13 | 13 |
Ligature | 0 | 0 | 0 | 0 |
Suture ligature | 1 | 1 | 136 | 136 |
Primary haemorrhage requiring intervention (Yes/No) | 1 | 1 | 136 | 136 |
Results
Inter-rater reliability of the variables concerning surgical information
n | Obs.agr. | Kappa (95% CI) | AC1 (95% CI) | |
---|---|---|---|---|
Indication of surgery | 137 | 0.92 | 0.87 (0.80 to 0.94) | 0.91 (0.85 to 0.96) |
Surgical Unit | 137 | 0.96 | 0.92 (0.85 to 0.99) | 0.93 (0.87 to 0.99) |
Primary or revision surgery | 137 | 0.99 | 0.66 (0.21 to 1) | 0.98 (0.96 to 1) |
Extent of surgery | 137 | 0.93 | 0.89 (0.83 to 0.96) | 0.91 (0.85 to 0.96) |
Inter-rater reliability of the variables concerning surgical technique
n | Obs.agr. | Kappa (95% CI) | AC1 (95% CI) | |
---|---|---|---|---|
Cold steel | 137 | 0.92 | 0.78 (0.66 to 0.91) | 0.87 (0.80 to 0.95) |
Radiofrequency | 137 | – | – | – |
Diathermy scissors | 137 | 0.94 | 0.83 (0.72 to 0.95) | 0.91 (0.85 to 0.97) |
Ultracision | 137 | 0.98 | 0.00 (0 to 0) | 0.98 (0.95 to 1) |
Laser | 137 | – | – | – |
Dissection with bipolar diathermy | 137 | 0.99 | 0.66 (0.04 to 1) | 0.99 (0.98 to 1) |
Other technique | 137 | – | – | – |
Inter-rater reliability of variables concerning technique for perioperative haemostasis
n | Obs.agr. | Kappa (95% CI) | AC1 (95% CI) | |
---|---|---|---|---|
Haemostasis achieved with compression only | 137 | 0.97 | 0.80 (0.61 to 0.99) | 0.97 (0.93 to 1) |
Infiltration with adrenalin | 137 | 0.99 | 0.91 (0.72 to 1) | 0.99 (0.98 to 1) |
Monopolar diathermy | 137 | 0.99 | 0.0 (0 to 0) | 0.99 (0.96 to 1) |
Bipolar diathermy | 137 | 0.96 | 0.75 (0.55 to 0.94) | 0.95 (0.90 to 0.99) |
Ligature | 137 | – | – | – |
Suture ligature | 137 | 1.00 | 1.00 (1 to 1) | 1.00 (1 to 1) |
Postoperative haemorrhage requiring intervention | 137 | 0.99 | 0.00 (−0.01 to 0.00) | 0.99 (0.97 to 1) |