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Paediatric Adenoidectomy: A Retrospective Cohort Study of Clinical Practice and Outcomes in NHS England (2008-2024)
Angus Lawson1,2, Paola Cognigni3, Kim Keltie1,3
1Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
Insights
Paediatric adenoidectomies in England show increasing readmission rates and a rise in day-case procedures. Further research is needed to assess technique-specific outcomes for improved patient counselling.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Health Services Research
Background:
- Adenoidectomy is a common procedure in children.
- Understanding trends and outcomes is crucial for optimizing care.
Purpose of the Study:
- To examine trends and outcomes of paediatric adenoidectomies in NHS England from 2008 to 2024.
- To provide data for accurate preoperative counselling.
Main Methods:
- Retrospective observational cohort study.
- Utilized Hospital Episode Statistics for children (≤16 years) undergoing adenoidectomy.
- Analyzed in-hospital complications, 28-day readmissions, mortality, and revision procedures.
Main Results:
- Over 351,000 adenoidectomies were performed; 6.1% resulted in readmission within 28 days.
- Hemorrhage rate was 3.4% overall, lower (0.7%) for isolated adenoidectomies.
- Emergency readmission rates increased, while day-case procedures rose significantly.
Conclusions:
- Paediatric adenoidectomy outcomes data can inform preoperative counselling.
- Current clinical coding limitations hinder technique-specific analysis.
- Improved coding and prospective studies are essential for detailed outcome assessment.
Objectives:
To examine trends and outcomes for paediatric adenoidectomies in NHS England between 2008 and 2024.
Design:
Retrospective observational cohort study using Hospital Episode Statistics.
Setting:
NHS trusts in England.
Participants:
Children (≤ 16 years) undergoing adenoidectomy.
Main Outcome Measures:
Adenoidectomies and concurrent procedures performed. In-hospital complications and readmissions within 28 days. All-cause mortality and revision procedures.
Results:
Between 2008 and 2024, 351 540 adenoidectomies were performed; 305 922 alongside ventilation tube insertion and/or tonsillectomy and 45 618 without these concurrent procedures. In-hospital complications occurred in 4422 admissions (1.3%) and 21 398 patients (6.1%) were readmitted within 28 days. Across all cases, the rate of haemorrhage was 3.4%, while in adenoidectomies occurring in the absence of concurrent ventilation tube insertion and/or tonsillectomy, the overall rate of haemorrhage was 0.7%, and 0.16% cases required return to theatre for surgical arrest of haemorrhage from the adenoid. Over the study period, emergency readmission rates rose from 3.8% to 6.7% while the proportion of day-case procedures increased from 46.3% to 81.1%. For adenoidectomies without concurrent ventilation tube insertion and/or tonsillectomy the rate of emergency admission rose from 2.07% to 2.91%, while adenoidectomies occurring concurrently alongside these procedures rose from 4.61% to 7.52%. The estimated overall revision rate was 4.52% (95% CI 4.44%-4.61%).
Conclusions:
This study describes key outcomes, providing the basis for accurate preoperative counselling in paediatric adenoidectomy. However, clinical coding does not capture surgical indication or technique, limiting procedure-specific assessment. Improved coding and prospective research are critically needed to examine technique-specific outcomes.
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