Effects of guidelines on adeno-tonsillar surgery on the clinical behaviour of otorhinolaryngologists in Italy

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• 作者：Giovanni Motta (1)
  Sergio Motta (2)
  Pasquale Cassano (3)
  Salvatore Conticello (4)
  Massimo Ferretti (5)
  Bruno Galletti (6)
  Aldo Garozzo (7)
  Gennaro Larotonda (8)
  Nicola Mansi (9)
  Emilio Mevio (10)
  Gaetano Motta (11)
  Giuseppe Quaremba (12)
  Agostino Serra (13)
  Vincenzo Tarantino (14)
  Paolo Tavormina (15)
  Claudio Vicini (16)
  Maurizio Giovanni Vigili (17)
  Domenico Testa (11)
  
• 关键词：Tonsillectomy ; Adeno ; tonsillectomy ; Otitis media ; Guidelines
• 刊名：BMC Ear, Nose and Throat Disorders
• 出版年：2013
• 出版时间：December 2013
• 年：2013
• 卷：13
• 期：1
• 全文大小：176KB
• 参考文献：1. Quality Improvement Committee of the AAO-HNS: / Clinical Indicators Tonsillectomy, Adenoidectomy, Adenotonsillectomy. 2000, 1-. AAO+HNSF: 01/01/2000. ISBN N°: SPPUB4301103
  2. Baugh RF, Archer SM, Mitchell RB, / et al.: Clinical practice guideline; tonsillectomy in children. / Otolaryngol Head Neck Surg 2011,144(1):1-0. CrossRef
  3. Scottish Intercollegiate Guidelines Network: / Management of Sore Throat and Indications for Tonsillectomy. SIGN Publication Number 34, Edinburgh; 1999. www.sign.ac.uk
  4. Scottish Intercollegiate Guidelines Network: / Management of Sore Throat and Indications for Tonsillectomy. SIGN Publication Number 117, Edinburgh; 2010. www.sign.ac.uk
  5. Programma Nazionale Linee G: / The clinical and organisational appropriateness of tonsillectomy and adenoidectomy. Policy Document; 2003. www.pnlg.it
  6. Sistema Nazionale Linee Guida: / Appropriateness and safety of tonsillectomy and/or adenoidectomy. 2008. www.snlg-iss.it
  7. Motta G, Casolino D, Cassiano B, / et al.: Adeno-tonsillar surgery in Italy. / Acta Otorhinolaryngol Ital 2008, 28:1-.
  8. Fedeli U, Marchesan M, Avossa F, Zambon F, Andretta M, Bussano I, Spolaore P: Variability of adenoidectomy/tonsillectomy rates among children of the Veneto Region Italy. / BMR Health Service Research 2009, 9:25. CrossRef
  9. Paradise JL, Bluestone CD, Bachman RZ, / et al.: Efficacy of tonsillectomy for recurrent throat infection in severely affected children: results of parallel randomized and nonrandomized clinical trials. / N Engl J Med 1984, 310:674-83. CrossRef
  10. Mitchell RB, Kelly J: Behavior, neurocognition and quality-of-life in children with sleep-disordered breathing. / Int J Pediatr Otorhinolaryngol 2006, 70:395-06. CrossRef
  11. Paradise JL, Bluestone CD, Kathleen Colborn D, / et al.: Adenoidectomy and Adenotosillectomy for recurrent acute otitis. / JAMA 1999, 282:945-54. CrossRef
  12. Van Staaij BK, Van den Akker EH, Rovers MM, Hordij K, / et al.: Effectiveness of adenotonsillectomy in children with mild symptoms of throat infections or adenotonsillar hypertrophy: open, randomised controlled trial. / BMJ 2004, 329:651-56. CrossRef
  13. Van Staaij BK, Van den Akker EH, der Heijden V, / et al.: Adenotonsillectomy for upper respiratory infections: evidence based. / Arch Dis Child 2005, 90:19-5. CrossRef
  14. Burton MJ, Towler B, Glasziou P: Tonsillectomy versus non-surgical treatment for chronic/recurrent acute tonsillitis. / Cochrane Database Syst Rev 1999, (2):CD001802.
  15. Darrow DH, Siemens C: Indications for tonsillectomy and adenoidectomy. / Laryngoscope 2002, 112:6-0. CrossRef
  16. Rosefsky JB: Tonsillectomies and adenotonsillectomies. Will the debate never be over? / Pediatrics 2003, 112:205. CrossRef
  17. Selimoglu E, Selimoglu MA, Orbak Z: Does adenotonsillectomy improve growth in children with obstructive adenotonsillar hypertrophy? / J Int Med Res 2003, 31:84-7.
  18. Basha S, Bialowas C, Ende K, Szeremeta W: Effectiveness of adenotonsillectomy in the resolution of nocturnal enuresis secondary to obstructive sleep apnea. / Laryngoscope 2005, 115:1101-103. CrossRef
  19. Erickson BK, Larson DR, St Sauver JL, Meverden RA, Orvidas LJ: Changes in incidence and indications of tonsillectomy and adenotonsillectomy, 1970-005. / Otolaryngol Head Neck Surg 2009, 140:894-01. CrossRef
  20. Parker NP, Walner DL: Trends in the indications for pediatric tonsillectomy or adenotonsillectomy. / Int J Pediatr Otorhinolaryngol 2011, 75:282-85. CrossRef
  21. Motta G, Esposito E, Motta S, / et al.: Surgical treatment of acute recurrent throat infections in children. / Auris Nasus Larynx 2011, 38:356-61. CrossRef
  22. van den Akker EH, Rovers MM, van Staaij BK, / et al.: Representativeness of trial populations: an example from a trial of adenotonsillectomy in children. / Acta Otolaryngol 2003, 123:297-01. CrossRef
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  27. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6815/13/1/prepub
  
• 作者单位：Giovanni Motta (1)
  Sergio Motta (2)
  Pasquale Cassano (3)
  Salvatore Conticello (4)
  Massimo Ferretti (5)
  Bruno Galletti (6)
  Aldo Garozzo (7)
  Gennaro Larotonda (8)
  Nicola Mansi (9)
  Emilio Mevio (10)
  Gaetano Motta (11)
  Giuseppe Quaremba (12)
  Agostino Serra (13)
  Vincenzo Tarantino (14)
  Paolo Tavormina (15)
  Claudio Vicini (16)
  Maurizio Giovanni Vigili (17)
  Domenico Testa (11)
  
  1. Institute of Otorhinolaryngology, University “Federico II- Naples, Italy
  2. Institute of Otorhinolaryngology, Department of Preventive Medical Sciences, University “Federico II- Naples, Italy
  3. Institute of Otorhinolaryngology, University of Foggia, Foggia, Italy
  4. Institute of Otorhinolaryngology, University of Torino, Torino, Italy
  5. Unit of Pediatric Otorhinolaryngology P.O.SS., Annunziata, Naples, Italy
  6. Institute of Otorhinolaryngology, University of Messina, Messina, Italy
  7. Institute of Otorhinolaryngology, University “Magna Graecia- Catanzaro, Italy
  8. Unit of Otorhinolaryngology, Hospital “Madonna delle Grazie- Matera, Italy
  9. S.C. of Otorhinolaryngology, Azienda Ospedaliera di Rilievo Nazionale Santobono-Pausillipon, Naples, Italy
  10. Unit of Otorhinolaryngology, Hospital “Fornaroli- Magenta, (Mi), Italy
  11. Institute of Otorhinolaryngology, II University of Naples, Naples, Italy
  12. Department of Forensic Medicine, University “Federico II- Naples, Italy
  13. Institute of Otorhinolaryngology, University of Catania, Catania, Italy
  14. S.C. of Otorhinolaryngology “Giannina Gaslini- Genoa, Italy
  15. Unit of Otorhinolaryngology, Pediatric Hospital “Regina Margherita S. Anna- Torino, Italy
  16. Unit of Otorhinolaryngology, A.U.S.L. of Forlì, Forlì, Italy
  17. Unit of Otorhinolaryngology, Hospital “San Carlo - IDI- Rome, Italy
  

文摘

Background Several guidelines on adeno-tonsillar disease have been proposed in recent years and some discrepancies in relation both to clinical manifestations and indications for surgical treatment have emerged. The aim of the study was to verify what influence (adeno)-tonsillectomy guidelines have had on the clinical behaviour of ENT specialists in Italy. Our study is a retrospective and multi-centre case series with chart review. Methods The survey involved 14,770 children, aged between the ages of 2 and 11, who had undergone adeno-tonsillar surgery between 2002 and 2008 in fourteen Italian tertiary and secondary referral centres. Anova test was used for the statistical analysis, assuming p < 0.05 as the minimum statistical significance value. Results The frequency of adeno-tonsillar surgeries did not change significantly (p>0.05) during the study period and following the Italian policy document publication. Overall, adeno-tonsillectomy was the most frequent intervention (64.1%), followed by adenoidectomy (31.1%) and tonsillectomy (4.8%). The indications for surgery did not change significantly for each of the operations (p>0.05), with the exception of adeno-tonsillectomy in case of feverish episodes due to acute recurrent tonsillitis ?5 without nasal obstruction (decreased p= 0.010) , even when the feverish episodes due to acute recurrent tonsillitis were < 5 over the last year. Nasal obstruction was associated with feverish episodes due to acute recurrent tonsillitis in 65.2% of operated cases, while otitis media had been diagnosed in 43.3% of the patients studied. Conclusions The recommendations first developed in Italy in a 2003 policy document and then resumed in guidelines in 2008, were not implemented by ENT units involved in the survey. The study highlights the fact that the indications for adeno-tonsillar operations are based on the overall clinical presentation (comorbidity) rather than on a single symptom. Guidelines are necessary to give coherent recommendations based on both the findings obtained through randomized controlled trials and the data collected from observational studies.