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

Fredrik Alm, Joacim Stalfors, Pia Nerfeldt, Elisabeth Ericsson, Fredrik Alm, Joacim Stalfors, Pia Nerfeldt, Elisabeth Ericsson

Abstract

The objective of this study was to describe factors affecting pain after pediatric tonsil surgery, using patient reported pain-related outcome measures (pain-PROMs) from the National Tonsil Surgery Register in Sweden. In total, 32,225 tonsil surgeries on children (1 to <18 years) during 2009-2016 were included; 13,904 tonsillectomies with or without adenoidectomy (TE ± A), and 18,321 tonsillotomies with or without adenoidectomy (TT ± A). Adjustments were made for variables included in the register to compensate for contributable factors in the analysis. When compared to TE ± A for surgical indication obstruction, TT ± A resulted in lower pain-PROMs, shorter use of postoperative analgesics, earlier return to regular food intake, and lower risk for contact with health care services due to pain. Children who underwent TE ± A because of obstruction problems stopped taking painkillers and returned to normal eating habits sooner, compared to children who underwent TE ± A for infectious indications. In both indication groups, TE ± A performed with hot rather than cold technique (dissection and haemostasis) generally resulted in higher pain-PROMs. Older children reported more days on analgesics and a later return to regular food intake after TE ± A than younger ones. No clinically relevant difference between sexes was found. Between 2012 and 2016 (pre-and post-implementation of Swedish national guidelines for pain treatment), the mean duration of postoperative analgesic use had increased. In conclusion, TE ± A caused considerably higher ratings of pain-related outcome measures, compared to TT ± A. For TE ± A, cold surgical techniques (dissection and haemostasis) were superior to hot techniques in terms of pain-PROMs. Older children reported higher pain-PROMs after TE ± A than younger ones.

Keywords: Children; PROM; Pain; Tonsillar hypertrophy; Tonsillectomy; Tonsillitis; Tonsillotomy.

Conflict of interest statement

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study. The present study was approved by the Central Ethical Board in Uppsala (application number 2016/445).

Conflict of interest

The authors declare that they have no conflict of interest.

Funding

The Swedish Association of Local Authorities and Regions funds the National Tonsil Surgery Register in Sweden.

Figures

Fig. 1
Fig. 1
Illustrates the unadjusted and adjusted mean difference, and 95% confidence interval (CI) in the number of days on postoperative analgesics between hot vs cold dissection technique, hot vs cold haemostasis technique, female vs male and age above vs below median for each surgical method indication group. † Adjusted mean difference for each of the four variables (dissection technique, haemostasis technique, sex and age) is presented, with adjustments made for the other three variables
Fig. 2
Fig. 2
Illustrates the unadjusted and adjusted mean difference and 95% confidence interval (CI) in number of days to regular eating habits between hot vs cold dissection technique, hot vs cold haemostasis technique, female vs male and age above vs below median for each surgical method indication group. † Adjusted mean difference for each of the four variables (dissection technique, haemostasis technique, sex and age) is presented, with adjustments made for the other three variables
Fig. 3
Fig. 3
For each surgical method indication group, unadjusted and adjusted odds ratio (OR) and 95% interval (CI) for contacts with health care service due to pain after surgery are presented for hot vs cold dissection technique, hot vs cold haemostasis technique, female vs male, and age above vs below median. † Adjusted odds ratio for each of the four variables (dissection technique, haemostasis technique, sex and age) is presented, with adjustments made for the other three variables
Fig. 4
Fig. 4
The line graph illustrates the mean duration in number of days with postoperative analgesics in 2012, 2013, 2014, 2015 and 2016 for each surgical method/indication group. The bar graph illustrates the percentage of contacts with health care services due to pain in 2012, 2013, 2014, 2015, and 2016. * The Swedish National guidelines for pain treatment were implemented in 2013, together with tailored patient information on the website http://www.tonsilloperation.se

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