Complications and their registration in otorhinolaryngology - head and neck surgery : special emphasis in tonsil surgery quality registration

Research output: ThesisDoctoral ThesisCollection of Articles

Abstract

The incidence of complications is one of the most commonly used outcome measure in surgery. Systematic registration of complications creates possibilities to monitor and improve quality of care, allows comparison between the treating units and provides tools for treatment decisions and patient education. Complication prevalence of three common procedures in Otorhinolaryngology – Head and Neck Surgery (ORL-HNS) was evaluated to discover predisposing factors for complications, and to develop a feasible prospective registration system for surgical complications in ORL-HNS. Additionally, this pursuit of register development has resulted in Department of ORL-HNS, HUH, participation in the Nordic Tonsil Surgery Register Collaboration (NTSRC). Postoperative complications of tonsil surgery and comprehensiveness of prospective complication data recording was assessed in 573 patients. The overall complication rate was 13.8%, with secondary hemorrhage being the most common complication (9.6%). Altogether 69.6% of patients with a complication were identified in prospective data retrieval. The pitfalls of registration process were assessed. Procedure-specific incidences of complications after benign parotid surgery and predictive factors for the postoperative facial nerve dysfunction were evaluated in 132 patients. On the first postoperative day, 40.2% of patients had facial palsy. Palsy rates in the subgroups of extracapsular dissection, partial superficial parotidectomy, superficial parotidectomy, and extended parotidectomy were 6.3%, 41.5%, 43.8%, and 53.8%, respectively. Age, duration of surgery and use of ultrasound knife were identified as independent risk factors for transient facial palsy. Third study evaluated the outcome of percutaneous endoscopic gastrostomy (PEG) inserted by ORL-HN surgeons and assessed the delays in comparison with earlier practice of referring the patients needing PEG to gastrointestinal surgeons. Four patients (3.2%) had a major complication. Peristomal granulomatous tissue was the most common minor complication (18.5%). Independence from gastrointestinal surgeons’ services reduced the time-delay and enhanced the availability of urgent PEG placements. The fourth study was a systematic literature review of tonsil surgery quality registers, and an introduction of the NTSRC, which is the first reported international register collaboration project within the specialty of ORL-HNS. The systematic review revealed five registries, quality improvement programs, or comprehensive audit programs with an inclusion principle of tonsil surgery. Two of them had ongoing activity. The three prospective studies acted as pilot projects for surgical complication registration at Department of ORL-HNS, HUH, and a long-term objective is to develop a systematic surgical quality register to our unit. One part of it is the tonsil surgery register, which features are more specifically discussed.
Original languageEnglish
Supervisors/Advisors
  • Bäck, Leif, Supervisor
  • Mäkitie, Antti, Supervisor
Place of PublicationHelsinki
Publisher
Print ISBNs978-951-51-4288-7
Electronic ISBNs978-951-51-4289-4
Publication statusPublished - 2018
MoE publication typeG5 Doctoral dissertation (article)

Fields of Science

  • Parotid Gland
  • +surgery
  • Tonsillectomy
  • Gastrostomy
  • Otorhinolaryngologic Surgical Procedures
  • +adverse effects
  • Postoperative Complications
  • Postoperative Hemorrhage
  • +epidemiology
  • Facial Nerve
  • +physiopathology
  • Head and Neck Neoplasms
  • Quality Improvement
  • Palatine Tonsil
  • Facial Paralysis
  • Documentation
  • Registries
  • Risk Factors
  • 3125 Otorhinolaryngology, ophthalmology
  • 3126 Surgery, anesthesiology, intensive care, radiology

Cite this

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title = "Complications and their registration in otorhinolaryngology - head and neck surgery : special emphasis in tonsil surgery quality registration",
abstract = "The incidence of complications is one of the most commonly used outcome measure in surgery. Systematic registration of complications creates possibilities to monitor and improve quality of care, allows comparison between the treating units and provides tools for treatment decisions and patient education. Complication prevalence of three common procedures in Otorhinolaryngology – Head and Neck Surgery (ORL-HNS) was evaluated to discover predisposing factors for complications, and to develop a feasible prospective registration system for surgical complications in ORL-HNS. Additionally, this pursuit of register development has resulted in Department of ORL-HNS, HUH, participation in the Nordic Tonsil Surgery Register Collaboration (NTSRC). Postoperative complications of tonsil surgery and comprehensiveness of prospective complication data recording was assessed in 573 patients. The overall complication rate was 13.8{\%}, with secondary hemorrhage being the most common complication (9.6{\%}). Altogether 69.6{\%} of patients with a complication were identified in prospective data retrieval. The pitfalls of registration process were assessed. Procedure-specific incidences of complications after benign parotid surgery and predictive factors for the postoperative facial nerve dysfunction were evaluated in 132 patients. On the first postoperative day, 40.2{\%} of patients had facial palsy. Palsy rates in the subgroups of extracapsular dissection, partial superficial parotidectomy, superficial parotidectomy, and extended parotidectomy were 6.3{\%}, 41.5{\%}, 43.8{\%}, and 53.8{\%}, respectively. Age, duration of surgery and use of ultrasound knife were identified as independent risk factors for transient facial palsy. Third study evaluated the outcome of percutaneous endoscopic gastrostomy (PEG) inserted by ORL-HN surgeons and assessed the delays in comparison with earlier practice of referring the patients needing PEG to gastrointestinal surgeons. Four patients (3.2{\%}) had a major complication. Peristomal granulomatous tissue was the most common minor complication (18.5{\%}). Independence from gastrointestinal surgeons’ services reduced the time-delay and enhanced the availability of urgent PEG placements. The fourth study was a systematic literature review of tonsil surgery quality registers, and an introduction of the NTSRC, which is the first reported international register collaboration project within the specialty of ORL-HNS. The systematic review revealed five registries, quality improvement programs, or comprehensive audit programs with an inclusion principle of tonsil surgery. Two of them had ongoing activity. The three prospective studies acted as pilot projects for surgical complication registration at Department of ORL-HNS, HUH, and a long-term objective is to develop a systematic surgical quality register to our unit. One part of it is the tonsil surgery register, which features are more specifically discussed.",
keywords = "Parotid Gland, +surgery, Tonsillectomy, Gastrostomy, Otorhinolaryngologic Surgical Procedures, +adverse effects, Postoperative Complications, Postoperative Hemorrhage, +epidemiology, Facial Nerve, +physiopathology, Head and Neck Neoplasms, Quality Improvement, Palatine Tonsil, Facial Paralysis, Documentation, Registries, Risk Factors, 3125 Otorhinolaryngology, ophthalmology, 3126 Surgery, anesthesiology, intensive care, radiology",
author = "Johanna Ruohoalho",
note = "M1 - 75 s. + liitteet",
year = "2018",
language = "English",
isbn = "978-951-51-4288-7",
series = "Dissertationes scholae doctoralis ad sanitatem investigandam universitatis helsinkiensis",
publisher = "Helsingin yliopisto",
number = "32/2018",
address = "Finland",

}

Complications and their registration in otorhinolaryngology - head and neck surgery : special emphasis in tonsil surgery quality registration. / Ruohoalho, Johanna.

Helsinki : Helsingin yliopisto, 2018. 75 p.

Research output: ThesisDoctoral ThesisCollection of Articles

TY - THES

T1 - Complications and their registration in otorhinolaryngology - head and neck surgery : special emphasis in tonsil surgery quality registration

AU - Ruohoalho, Johanna

N1 - M1 - 75 s. + liitteet

PY - 2018

Y1 - 2018

N2 - The incidence of complications is one of the most commonly used outcome measure in surgery. Systematic registration of complications creates possibilities to monitor and improve quality of care, allows comparison between the treating units and provides tools for treatment decisions and patient education. Complication prevalence of three common procedures in Otorhinolaryngology – Head and Neck Surgery (ORL-HNS) was evaluated to discover predisposing factors for complications, and to develop a feasible prospective registration system for surgical complications in ORL-HNS. Additionally, this pursuit of register development has resulted in Department of ORL-HNS, HUH, participation in the Nordic Tonsil Surgery Register Collaboration (NTSRC). Postoperative complications of tonsil surgery and comprehensiveness of prospective complication data recording was assessed in 573 patients. The overall complication rate was 13.8%, with secondary hemorrhage being the most common complication (9.6%). Altogether 69.6% of patients with a complication were identified in prospective data retrieval. The pitfalls of registration process were assessed. Procedure-specific incidences of complications after benign parotid surgery and predictive factors for the postoperative facial nerve dysfunction were evaluated in 132 patients. On the first postoperative day, 40.2% of patients had facial palsy. Palsy rates in the subgroups of extracapsular dissection, partial superficial parotidectomy, superficial parotidectomy, and extended parotidectomy were 6.3%, 41.5%, 43.8%, and 53.8%, respectively. Age, duration of surgery and use of ultrasound knife were identified as independent risk factors for transient facial palsy. Third study evaluated the outcome of percutaneous endoscopic gastrostomy (PEG) inserted by ORL-HN surgeons and assessed the delays in comparison with earlier practice of referring the patients needing PEG to gastrointestinal surgeons. Four patients (3.2%) had a major complication. Peristomal granulomatous tissue was the most common minor complication (18.5%). Independence from gastrointestinal surgeons’ services reduced the time-delay and enhanced the availability of urgent PEG placements. The fourth study was a systematic literature review of tonsil surgery quality registers, and an introduction of the NTSRC, which is the first reported international register collaboration project within the specialty of ORL-HNS. The systematic review revealed five registries, quality improvement programs, or comprehensive audit programs with an inclusion principle of tonsil surgery. Two of them had ongoing activity. The three prospective studies acted as pilot projects for surgical complication registration at Department of ORL-HNS, HUH, and a long-term objective is to develop a systematic surgical quality register to our unit. One part of it is the tonsil surgery register, which features are more specifically discussed.

AB - The incidence of complications is one of the most commonly used outcome measure in surgery. Systematic registration of complications creates possibilities to monitor and improve quality of care, allows comparison between the treating units and provides tools for treatment decisions and patient education. Complication prevalence of three common procedures in Otorhinolaryngology – Head and Neck Surgery (ORL-HNS) was evaluated to discover predisposing factors for complications, and to develop a feasible prospective registration system for surgical complications in ORL-HNS. Additionally, this pursuit of register development has resulted in Department of ORL-HNS, HUH, participation in the Nordic Tonsil Surgery Register Collaboration (NTSRC). Postoperative complications of tonsil surgery and comprehensiveness of prospective complication data recording was assessed in 573 patients. The overall complication rate was 13.8%, with secondary hemorrhage being the most common complication (9.6%). Altogether 69.6% of patients with a complication were identified in prospective data retrieval. The pitfalls of registration process were assessed. Procedure-specific incidences of complications after benign parotid surgery and predictive factors for the postoperative facial nerve dysfunction were evaluated in 132 patients. On the first postoperative day, 40.2% of patients had facial palsy. Palsy rates in the subgroups of extracapsular dissection, partial superficial parotidectomy, superficial parotidectomy, and extended parotidectomy were 6.3%, 41.5%, 43.8%, and 53.8%, respectively. Age, duration of surgery and use of ultrasound knife were identified as independent risk factors for transient facial palsy. Third study evaluated the outcome of percutaneous endoscopic gastrostomy (PEG) inserted by ORL-HN surgeons and assessed the delays in comparison with earlier practice of referring the patients needing PEG to gastrointestinal surgeons. Four patients (3.2%) had a major complication. Peristomal granulomatous tissue was the most common minor complication (18.5%). Independence from gastrointestinal surgeons’ services reduced the time-delay and enhanced the availability of urgent PEG placements. The fourth study was a systematic literature review of tonsil surgery quality registers, and an introduction of the NTSRC, which is the first reported international register collaboration project within the specialty of ORL-HNS. The systematic review revealed five registries, quality improvement programs, or comprehensive audit programs with an inclusion principle of tonsil surgery. Two of them had ongoing activity. The three prospective studies acted as pilot projects for surgical complication registration at Department of ORL-HNS, HUH, and a long-term objective is to develop a systematic surgical quality register to our unit. One part of it is the tonsil surgery register, which features are more specifically discussed.

KW - Parotid Gland

KW - +surgery

KW - Tonsillectomy

KW - Gastrostomy

KW - Otorhinolaryngologic Surgical Procedures

KW - +adverse effects

KW - Postoperative Complications

KW - Postoperative Hemorrhage

KW - +epidemiology

KW - Facial Nerve

KW - +physiopathology

KW - Head and Neck Neoplasms

KW - Quality Improvement

KW - Palatine Tonsil

KW - Facial Paralysis

KW - Documentation

KW - Registries

KW - Risk Factors

KW - 3125 Otorhinolaryngology, ophthalmology

KW - 3126 Surgery, anesthesiology, intensive care, radiology

M3 - Doctoral Thesis

SN - 978-951-51-4288-7

T3 - Dissertationes scholae doctoralis ad sanitatem investigandam universitatis helsinkiensis

PB - Helsingin yliopisto

CY - Helsinki

ER -

Ruohoalho J. Complications and their registration in otorhinolaryngology - head and neck surgery : special emphasis in tonsil surgery quality registration. Helsinki: Helsingin yliopisto, 2018. 75 p. (Dissertationes scholae doctoralis ad sanitatem investigandam universitatis helsinkiensis; 32/2018 ).