Dolder, M.N. van den (2017) Patient-reported outcomes in peritonsillar abscess sufferers: a prospectivestudy comparing incisional drainage to tonsillectomy à chaud. thesis, Medicine.
Full text available on request.Abstract
Introduction: Worldwide there is no consensus about the best surgical intervention for peritonsillar abscess. As a consequence, great variety exists in first-line treatment. Needle aspiration, incision drainage and tonsillectomy à chaud are all proven effective interventions. All have their own advantages and disadvantages, concerning complications, success rates and costs of treatment. Till date no study has compared patients’ experiences, or so-called patient related outcomes, between these treatments. In this study the impact of tonsillectomy à chaud and incisional drainage on patient related outcomes are compared one month after surgery. Methods: This prospective study in the Netherlands included 26 patients in Deventer Hospital receiving tonsillectomy à chaud as first-line treatment vs. 15 patients in Apeldoorn Gelre Hospital receiving incisional drainage. Patient related outcomes were evaluated by use of the tonsil outcome inventory (TOI, before and 1 month after surgery). Pain of the throat was examined by VAS scores (before, 1 day after and 1 month after surgery). Missed working days (during the first month) due to throat-problems were administered. Secondly, complications of both procedures were recorded during the first month: postoperative haemorrhage after tonsillectomy à chaud and recurrence of PTA after incisional drainage, with possible planned interval tonsillectomy. Results: Patients reported better TOI scores and VAS scores for both treatments (all P<0,005). Median TOI scores after TAC improved from 54,29 to 35,71 vs. 51,43 to 8,57 when receiving ID. Median VAS scores improved from 8 (before surgery) to 6 (1day after surgery), and 2 (1 month after surgery) when receiving TAC vs. 9 (before surgery), 4 (1 day after surgery), 0 (1 month after surgery) for incisional drainage. Median difference of TOI scores after one month improved 48,57 after ID vs 35,71 after tonsillectomy à chaud, although differences between both groups were not statically significant. (P=0,287). Median VAS scores improved 4 points 1 day after ID vs. 2 points after TAC (P=0,054). After one month median improvement of VAS scores were better after ID: 8 vs. 5 when receiving TAC (P=0,004). Patients receiving ID had significantly less missed working days in the first month afterwards (median): 9 vs. 4 after TAC (P=0,03). 1 out of 26 patients (3.8%) had postoperative bleeding after TAC. 2 out of 15 patients (13.3%) had recurrence of PTA. 1 patient had two recurrences. Both patients were treated with TAC eventually. No one was scheduled for interval tonsillectomy yet. Conclusion: ID seems slightly favourable in terms of patient related outcomes compared to tonsillectomy à chaud in the short term. However, more patients and longer follow-up is needed to investigate these patient related outcomes, since complications and necessity for surgery in the future is of concern. Both surgical interventions still have their own risks and benefits, and shared decision making and informed consent should lead to the best type of surgical treatment.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultair begeleider: and Bom, Dr. S.J.H. and Vakgroep: Keel-neus-oorheelkunde, Deventer Ziekenhuis |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:56 |
| Last Modified: | 25 Jun 2020 10:56 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1675 |
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