Ricerca
Adenotonsillectomia in Pediatria
Adenotonsillectomy in Paediatrics
Aldo Ravaglia1, Roberto Gnavi 2, Alessandro Vigo3, Silvia Noce3, Andrea Guala4, Alberto Borraccino5, Gruppo di lavoro sulle ADT
1Pediatra di famiglia, Chivasso (Torino); 2Servizio sovra-zonale di Epidemiologia, ASL Torino 3, Regione Piemonte; 3Centro SIDS Regione Piemonte, AO Ospedale Infantile “Regina Margherita” - “S. Anna”, Torino; 4SC di Pediatria, Ospedale “Castelli”, Verbania; 5Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Università di Torino
Giugno 2018 - pagg. 385 -390
Abstract
Background - Adenotonsillectomy is among the most frequent surgical intervention in paediatric
age. Although the availability of several recommendations on the clinical and organizational
approach to be followed, there is evidence of an important variability, both
at the national, and at the regional level as well within local districts. The Piedmont Regional
Health Authority has addressed the issue of the quality of adenotonsillary surgery
in paediatrics by involving several professionals with the aim of improving safety and
overall quality of the clinical and organizational adenotonsillary pathway.
Purpose - Aim of this work is to describe the results that have characterised the last thirteen years on the activities undertaken by health professionals and the health local government division in the Piedmont Region on the adenotonsillary surgery.
Materials and methods - The whole process is reported by describing the epidemiological situation and the variability of adenotonsillary surgery from 1998 to 2015 and by describing the clinical-organizational choices that have contributed to the observed change.
Results and conclusions - Despite of a continuous decrease in the number of interventions, that has reduced from about 126 to 50 surgeries per 10,000 children between 1998 and 2015, an important variability among local health districts is still present. Part of this reduction seems to be due to the prominent role of the Regional Health Authority, which has established a multidisciplinary professional group, facilitated the dissemination and adaptation of the national guidelines to the Piedmont area reality and has promoted several trainings. But above all, such reduction seems to be attributable to the innovative multi- disciplinary approach used, which has allowed the involved professionals to be the real leaders of the observed change.
Purpose - Aim of this work is to describe the results that have characterised the last thirteen years on the activities undertaken by health professionals and the health local government division in the Piedmont Region on the adenotonsillary surgery.
Materials and methods - The whole process is reported by describing the epidemiological situation and the variability of adenotonsillary surgery from 1998 to 2015 and by describing the clinical-organizational choices that have contributed to the observed change.
Results and conclusions - Despite of a continuous decrease in the number of interventions, that has reduced from about 126 to 50 surgeries per 10,000 children between 1998 and 2015, an important variability among local health districts is still present. Part of this reduction seems to be due to the prominent role of the Regional Health Authority, which has established a multidisciplinary professional group, facilitated the dissemination and adaptation of the national guidelines to the Piedmont area reality and has promoted several trainings. But above all, such reduction seems to be attributable to the innovative multi- disciplinary approach used, which has allowed the involved professionals to be the real leaders of the observed change.
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Classificazione MeSH
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Bibliografia
1. Crowson MG, Ryan MA, Rocke DJ, Raynor
EM, Puscas L. Variation in tonsillectomy rates
by health care system type. Int J Pediatr Otorhinolaryngol
2017;94:40-4.
2. Donaldson LJ, Hayes JH, Barton AG, Howel
D, Hawthorne M. Impact of clinical practice
guidelines on clinicians’ behaviour: tonsillectomy
in children. J Otolaryngol 1999;28(1):24-
30.
3. Fedeli U, Marchesan M, Avossa F, et al. Variability
of adenoidectomy/tonsillectomy rates
among children of the Veneto Region, Italy.
BMC Health Serv Res 2009;9:25.
4. Lescanne E, Chiron B, Constant I, et al.;
French Society of ENT (SFORL); French Association
for Ambulatory Surgery (AFCA); French
Society for Anaesthesia, Intensive Care
(SFAR). Pediatric tonsillectomy: clinical practice
guidelines. Eur Ann Otorhinolaryngol Head
Neck Dis 2012;129(5):264-71.
5. Marchisio P, Villa M, Bellussi L, Materia E,
Perletti L. Linee Guida ministeriali. Appropriatezza
e sicurezza degli interventi di tonsillectomia
e/o adenoidectomia. Minerva Pediatrica
2008;60(5):907-9.
6. Materia E, Baglio G, Bellussi L, et al. The clinical
and organisational appropriateness of tonsillectomy
and adenoidectomy - an Italian perspective.
Int J Pediatr Otorhinolaryngol 2005;69
(4):497-500.
7. Materia E, Di Domenicantonio R, Baglio G,
et al. Epidemiology of tonsillectomy and/or
adenoidectomy in Italy. Pediatr Med Chir
2004;26(3): 179-86.
8. Wasserzug O, Fishman G, Sternbach D, et al.
Informed consent for tonsillectomy: do parents
comprehend the information we provide? Int J
Pediatr Otorhinolaryngol 2016;88: 163-7.
9. Ubayasiri K, Kothari R, McClelland L, De M.
Patient attitudes to tonsillectomy. Int J Family
Med 2012;2012:735684.
10. Istituto Superiore di Sanità. Appropriatezza
clinica e organizzativa degli interventi di tonsillectomia
e/o adenoidectomia. Documento di indirizzo.
In: ISS-PNLG ed., 2003.
11. Longo G, Marchetti F, Zocconi E. Commenti
sul Documento di indirizzo sull’adenotonsillectomia
(ADT). Medico e Bambino
2003;22(7):452-3.
12. Istituto Superiore di Sanità. Appropriatezza
e sicurezza degli interventi di tonsillectomia
e/o adenoidectomia. Roma: ISS-SNL-G15, 2008.
13. Regione Piemonte. Raccomandazioni regionali
per l’appropriatezza e sicurezza degli interventi
di tonsillectomia e/o adenoidectomia in
età pediatrica. 2014. http:// www.Regione.piemonte.
it/sanita/cms2/area-materno-infantile/
percorso-crescita/4848-indicazioni-per-la-tonsillectomia.
14. AAP. Clinical practice guideline: diagnosis
and management of childhood obstructive
sleep apnea syndrome. Pediatrics 2002;
109:704-12.
15. Baugh RF, Archer SM, Mitchell RB, et al;
American Academy of Otolaryngology-Head
and Neck Surgery Foundation. Clinical practice
guideline: tonsillectomy in children. Otolaryngol
Head Neck Surg 2011;144(1 Suppl):S1-30.
16. De Vincentiis GC, Sitzia E, Panatta ML.
OSAS in eta% pediatrica. Quaderni acp 2014;
21:244-51.
17. Chee Y, Crawford J, Watson H, Greaves M.
Guidelines on the assessment of bleeding risk
prior to surgery or invasive procedures. Br J
Haematol. 2008;140(5):496-504.
18. Juul ML, Rasmussen ER, Rasmussen SHR,
Sørensen CH, Howitz MF. A nationwide registry-
based cohort study of incidence of tonsillectomy
in Denmark, 1991-2012. Clin Otolaryngol
2018;43(1):274-84.
Corrispondenza: alberto.borraccino@unito.it