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

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.