Systematic review of tonsil surgery quality registers and introduction of the Nordic Tonsil Surgery Register Collaboration
Surgical quality registers provide tools to measure and improve the outcome of surgery. International register collaboration creates an opportunity to assess and critically evaluate national practices, and increases the size of available datasets. Even though millions of yearly tonsillectomies and tonsillotomies are performed worldwide, clinical practices are variable and inconsistency of evidence regarding the best clinical practice exists. The need for quality improvement actions is evident. We aimed to systematically investigate the existing tonsil surgery quality registers found in the literature, and to provide a thorough presentation of the planned Nordic Tonsil Surgery Register Collaboration.
A systematic literature search of MEDLINE and EMBASE databases (from January 1990 to December 2016) was conducted to identify registers, databases, quality improvement programs or comprehensive audit programs addressing tonsil surgery.
We identified two active registers and three completed audit programs focusing on tonsil surgery quality registration. Recorded variables were fairly similar, but considerable variation in coverage, number of operations included and length of time period for inclusion was discovered.
Considering tonsillectomies and tonsillotomies being among the most commonly performed surgical procedures in otorhinolaryngology, it is surprising that only two active registers could be identified. We present a Nordic Tonsil Surgery Register Collaboration—an international tonsil surgery quality register project aiming to provide accurate benchmarks and enhance the quality of tonsil surgery in Denmark, Finland, Norway and Sweden.
KeywordsQuality assurance Surgical quality Tonsillectomy Tonsillotomy Registry Database
This study was funded by NordForsk foundation (Grant no. 971274255).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
Data from the Norwegian Patient Register has been used in this publication. The interpretation and reporting of these data are the sole responsibility of the authors, and no endorsement by the Norwegian patient register is intended nor should be inferred.
- 1.Official webpage of Swedish National Quality Registries. http://www.kvalitetsregister.se/. Accessed 12 Apr 2017
- 2.National Institute of Health and Welfare, Finland (2017). https://www.thl.fi/en/web/thlfi-en. Accessed 24 Jul 2017
- 3.Official webpage of Norwegian national quality register (2017). https://www.kvalitetsregistre.no. Accessed 20 Sep 2017
- 4.Statens Serum Institute, Denmark (2017). http://www.ssi.dk/English.aspx. Accessed 24 Jul 2017
- 5.Hessen Soderman AC, Ericsson E, Hemlin C, Hultcrantz E, Mansson I, Roos K, Stalfors J (2011) 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 121(11):2322–2326CrossRefPubMedGoogle Scholar
- 8.Burton MJ, Glasziou PP, Chong LY, Venekamp RP (2014) Tonsillectomy or adenotonsillectomy versus non-surgical treatment for chronic/recurrent acute tonsillitis. Cochrane Database Syst Rev 11:CD001802Google Scholar
- 9.Hollis LJ, Burton MJ, Millar JM (2000) Perioperative local anaesthesia for reducing pain following tonsillectomy. Cochrane Database Syst Rev 2(2):CD001874Google Scholar
- 10.Lim J, McKean MC (2009) Adenotonsillectomy for obstructive sleep apnoea in children. Cochrane Database Syst Rev 2:CD003136Google Scholar
- 11.Pinder DK, Wilson H, Hilton MP (2011) Dissection versus diathermy for tonsillectomy. Cochrane Database Syst Rev 3:CD002211Google Scholar
- 17.Soderman AC, Odhagen E, Ericsson E, Hemlin C, Hultcrantz E, Sunnergren O, Stalfors J (2015) 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 40(3):248–254CrossRefPubMedGoogle Scholar
- 19.Hultcrantz E, Ericsson E, Hemlin C, Hessen-Soderman AC, Roos K, Sunnergren O, Stalfors J (2013) Paradigm shift in Sweden from tonsillectomy to tonsillotomy for children with upper airway obstructive symptoms due to tonsillar hypertrophy. Eur Arch Otorhinolaryngol 270(9):2531–2536CrossRefPubMedGoogle Scholar
- 24.Public Health Wales annual report 2015: Tonsillectomy and adenoidectomy single-use instrument surveillance (2016). http://www.wales.nhs.uk/sites3/Documents/457/All%20Wales%20Annual%20Tonsillectomy%20and%20Adenoidectomy%20Single-Use%20Instrument%20Surveillance%20Report%202015.pdf. Accessed 20 Feb 2018
- 29.The Royal College of Surgeons of England, England (2005) National Prospective Tonsillectomy Audit final report. The Royal College of Surgeons of EnglandGoogle Scholar
- 34.Scotland Scottish Otolaryngology Society (2008) A Scottish prospective audit of tonsil and adenoid surgery with disposable surgical instruments—Final reportGoogle Scholar
- 36.Officiel webpages for tonsil surgery register of Sweden (2017) https://ton.registercentrum.se. Accessed 20 Feb 2018
- 37.Department of Health. Risk assessment for transmission of vCJD via surgical instruments: a modelling approach and numerical scenarios (2001). http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4084657.pdf. Accessed 20 Feb 2018
- 38.Public Health Wales Clinical Instrument Surveillance Program webpage (2015). http://www.wales.nhs.uk/sites3/page.cfm?orgid=457&pid=53285. Accessed 23 Mar 2018
- 45.Stehlik J, Hosenpud JD, Edwards LB, Hertz MI, Mehra MR, International Society for Heart and Lung Transplantation (2013) ISHLT international registry for heart and lung transplantation—into the fourth decade, from strength to strength. J Heart Lung Transplant 32(10):941–950CrossRefPubMedGoogle Scholar
- 48.Porter M, Teisberg E (2006) Redefining health care: creating value-based competition on results. Harvard Business Press, BostonGoogle Scholar
- 49.The International Consortium for Health Outcomes Measurement (2015) What matters most: patient outcomes and the transformation of health care. http://www.ichom.org/book/. Accessed 13 Sep 2017
- 50.Stalfors J, Ericsson E, Hemlin C, Hessen Soderman AC, Odhagen E, Sunnergren O (2014) Annual report for the National Tonsil Surgery Register in Sweden 2013. Karolinska University Hospital. Stockholm, SwedenGoogle Scholar
- 51.Officiel webpage of The National Tonsil Surgery Register of Sweden. https://ton.registercentrum.se/. Accessed 12 Sep 2017
- 53.Organization for Economic Co-operation and Development, OECD. Statistics of surgical procedures 2014. http://stats.oecd.org/. Accessed 20 Feb 2018
- 54.National Institute of Health and Welfare, Finland. Specialised Health Care - Database of Annual Number of Preocedures (in Finnish). https://sampo.thl.fi/pivot/prod/fi/thil/perus01/fact_thil_perus01?row=operation_type-189769&column=time-6656. Accessed 23 Mar 2018
- 55.Norwegian Patient Register (2017) Annual number of tonsil surgery procedures in 2014. https://helsedirektoratet.no/english/norwegian-patient-registry
- 56.Månsson I (ed) (2009) Report on indications for tonsil surgery in Sweden (in Swedish). Sveriges Kommuner och Landsting, Stockholm, SwedenGoogle Scholar
- 57.Ministry of Social Affairs and Health (2010) Uniform criteria for access to non-emergency treatment 2010. 2nd edn. (in Finnish). Helsinki, FinlandGoogle Scholar
- 58.National clinical guideline for the removal of tonsils (tonsillectomy) (2016) Danish Health Authority. https://www.sst.dk/en/publications/2016/~/media/EB34FB643B2743C698CB445B775EAE9B.ashx. Accessed 23 Mar 2018