Practice, complications and outcome in Swedish tonsil surgery 2009–2018. An observational longitudinal national cohort study

Figures & data

Figure 1. The eight main groups of the NTSRS population, characteristics and trends 2009–2018. Presented with APCs and 99% CI. * APC significantly different from zero at the 0.01 level. † Trend shift/Join point in 2014.

Figure 2. Rates of surgical techniques for TE and TT (in TE/TEA and TT/TTA procedures) 2009-2018. Presented with APCs and 99% CI. ‘Undefinable techniques’ is not presented in figure. *APC significantly different from zero at the 0.01 level. † Trend shift/Join point in in 2013.

Table 1. Relative risks (RR) for postoperative bleedings related to surgical technique for dissection and haemostasis of the tonsils.

		TE (TE + TEA procedures)			TT (TT + TTA procedures)
Bleeding during hospital stay	Number of patients	Number of bleedings (%)	RR (99% CI), p-value	Number of patients	Number of bleedings (%)	RR (99% CI), p-value
Undefinable technique	1869	50 (2.7%)		286	2 (0.7%)
Cold dissection + Cold haemostasis	7905	209 (2.6%)	1	506	5 (1.0%)	1
Cold dissection + Hot haemostasis	31141	1025 (3.3%)	1.12 (0.92–1.37), .13	807	15 (1.9%)	1.88 (0.50–7.06), .22
Hot dissection + Hot haemostasis (all hot tech.)	14050	306 (2.2%)	0.76 (0.60–0.97), .0036	37669	349 (0.9%)	1.04 (0.29–3.79), .93
Diathermy scissors	7891	139 (1.8%)	0.70 (0.52–0.94), .002	2706	17 (0.6%)	0.64 (0.17–2.34), .37
Radiofrequency	3601	123 (3.4%)	1.20 (0.88–1.62), .13	33687	329 (1.0%)	1.10 (0.30–3.99), .85
Ultracision	600	4 (0.7%)	0.26 (0.07–0.99), .0096	555	2 (0.4%)	0.36 (0.04–3.13), .23
Bipolar diathermy	427	14 (3.3%)	1.02 (0.50–2.08), .94	11	0 (0%)	–
Undefinable hot dissection	1531	26 (1.7%)		710	1 (0.1%)
Contact due to bleeding	Number of patients	Number of bleedings (%)	RR (99% CI), p-value	Number of patients	Number of bleedings (%)	RR (99% CI), p-value
Undefinable technique	880	70 (7.9%)		229	7 (3.1%)
Cold dissection + Cold haemostasis	4181	195 (4.7%)	1	382	6 (1.6%)	1
Cold dissection + Hot haemostasis	18280	1964 (10.7%)	2.19 (1.81–2.64), <.0001	458	20 (4.4%)	2.47 (0.75-8.16), 0.051
Hot dissection + Hot haemostasis (all hot tech.)	7390	1158 (15.7%)	3.06 (2.51–3.73), <.0001	22173	414 (1.9%)	1.19 (0.42-3.40), 0.66
Diathermy scissors	3681	602 (16.4%)	3.04 (2.47–3.74), <.0001	1106	28 (2.5%)	1.77 (0.56-5.57), 0.20
Radiofrequency	2186	302 (13.8%)	2.88 (2.25–3.68), <.0001	20286	379 (1.9%)	1.10 (0.30-3.99), 0.85
Ultracision	410	71 (17.3%)	3.17 (2.16–4.65), <.0001	405	4 (1.0%)	0.63 (0.12-3.28), 0.47
Bipolar diathermy	229	48 (21.0%)	3.90 (2.62–5.82), <.0001	8	0 (0%)	–
Undefinable hot dissection	884	135 (15.3%)		368	3 (0.8%)
Admission due to bleeding	Number of patients	Number of bleedings (%)	RR (99% CI), p-value	Number of patients	Number of bleedings (%)	RR (99% CI), p-value
Undefinable technique	873	49 (5.6%)		223	3 (1.3%)
Cold dissection + Cold haemostasis	4078	114 (2.8%)	1	369	2 (0.5%)	1
Cold dissection + Hot haemostasis	18075	1405 (7.8%)	2.61 (2.04–3.35), <.0001	443	17 (3.8%)	7.08 (1.04–48.15), .0085
Hot dissection + Hot haemostasis (all hot tech.)	7308	829 (11.3%)	3.60 (2.78–4.66), <.0001	21776	226 (1.0%)	1.93 (0.31–11.92), .35
Diathermy scissors	3641	436 (11.9%)	3.59 (2.74–4.70), <.0001	1041	17 (1.6%)	3.01 (0.44–20.54), .14
Radiofrequency	2159	198 (9.1%)	3.15 (2.29–4.34), <.0001	19962	206 (1.0%)	1.91 (0.31–11.84), .36
Ultracision	409	49 (11.9%)	3.37 (2.09–5.45), <.0001	402	1 (0.2%)	0.46 (0.02–10.70), .52
Bipolar diathermy	222	40 (17.8%)	5.88 (3.61–9.58), <.0001	8	0 (0%)	–
Undefinable hot dissection	877	106 (12.1%)		363	2 (0.6%)

RRs are adjusted for surgery method, age, gender and indication. RRs in italic style are non-adjusted due to too few bleeding events. Only patients where data is available are included in the table.

Figure 3. Rates of bleeding complications 2009-2018. Presented with APCs and 99% CI. * APC significantly different from zero at the 0.01 level. † Trend shift/Join point in 2012. ‡ TT snoring APC could not be calculated as no bleedings occurred in 2011.

Figure 4. Rates of contact due to pain 2009–2018. Presented with APCs and 99% CI.

Figure 5. Rates of patients reporting ‘The symptoms are gone’ 6 months after surgery 2009–2018. Presented with APCs and 99% CI. * APC significantly different from zero at the 0.01 level.

Data sharing

Data from the NTSRS is regulated by Swedish law. Research using NTSRS data may be carried out following approval by an ethics committee. Please contact the Centre of Registers Västra Götaland for more information ([email protected]).