TonsillectomyNTSRSNCT02829515
Tonsil Surgery in Sweden: A National Quality Register
An observational study of Tonsillectomy and Prospective Studies, run by Joacim Stalfors at 1 site in Sweden.
Trial summary
For the purpose of quality assurance, the Swedish Association for Otorhinolaryngology and Head and Neck surgery has developed several national registers concerning ear, nose and throat care. One of these is the National Tonsil Surgery Registry in Sweden (NTSRS). Read more about this study
- Who is it for?
- Any ageHealthy volunteers can take part
- Conditions the study is for
- Tonsillectomy, Prospective Studies, Registries
- What is being tested?
- tonsil surgery with or without concomitant adenoidectomy
- Type of treatment
- Surgery or procedure
- How many people
- 11,000 participants
- Where
- 1 siteSweden
- Study dates
- May 2009to Dec 2019
- How long will I take part?
- 6 Months
- Phase
- Observational
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages Any age
- All sexes
- Healthy volunteers accepted
- Child, Adult, Older adult
Study population: All patients undergoing benign tonsil surgery in Sweden
Who may be able to join
- All patients undergoing benign tonsil surgery in Sweden
Who cannot join
- All patients operated with an C- or D0-48 ICD 10 code, indicating not benign diagnoses
Trial locations and contacts
1 site in 1 country.
Lisa Hellgård contact
Sweden1 site, 1 recruiting
- Recruiting
National Tonsil Surgery Register in Sweden
Gothenburg, 41345
Lisa Hellgård, MSc, Lisa.Hellgard@registercentrum.se
About this study
Official title: The National Tonsil Surgery Register in Sweden
For the purpose of quality assurance, the Swedish Association for Otorhinolaryngology and Head and Neck surgery has developed several national registers concerning ear, nose and throat care. One of these is the National Tonsil Surgery Registry in Sweden (NTSRS). In NTSRS patients undergoing tonsil surgery for benign indications are included. Data regarding indication, surgical methods and techniques as well as patient reported outcomes measures are collected. The register is designed to facilitate description of clinical activities in a unit and help identify the need of clinical improvement programs. By compiling national data, the register can be used to describe clinical practice in a large national cohort.
Read the detailed description
The National Tonsil Surgery Register in Sweden (NTSRS), started in 1997 as one among several registers, aimed to reinforce quality in the Swedish health care and were revised 2009. Data in the NTSRS are collected through four questionnaires; two are filled in by the ENT-surgeon and two postoperative forms, filled in by the patient or the legal guardian, collecting patient related outcome measures (PROM) 30 respective 180 days after surgery.
In the first surgeon questionnaire age, sex, social security number and indication for surgery (upper airway obstruction, recurrent tonsillitis, chronic tonsillitis, peritonsillar abscess, and systemic complications because of tonsillitis or other) are recorded. This is filled in when surgery is notified.
The second surgeon questionnaire records surgical method (TE, TEA, TT or TTA), surgical instruments used for dissection (cold steel, radiofrequency, diathermy scissors, ultracision or other) and hemostasis method used (injection with epinephrine, unipolar diathermy, bipolar diathermy, ties, suture ligature, radiofrequency, other or "none other than compression with packs"). The questionnaire also records information regarding daycare/inpatient procedure and primary postoperative bleeding. Due to the configuration of the questionnaires and the ambition to cover both inpatient and daycare procedures, primary bleeding is defined as bleeding during hospitalization.
The first patient/caregiver form contains several questions mainly regarding postoperative complications. Any contact with healthcare provider due to postoperative bleeding/pain/infection as well as consequences of the contact; prescribed antibiotics and readmission/return to theatre are reported. Conformity between preoperative information and actual patient experience was is also included in this form.
The final questionnaire that is sent to the second patient/caregiver questionnaire asks for perceived symptom relief after 180 days by choosing one alternative of four statements: My symptoms are gone / My symptoms are almost gone / My symptoms have not disappeared/ My symptoms have worsened.
In order to assess coverage for the NTSRS, data has been matched on an individual level with another national register, the National Patient Register (NPR). The NPR is managed by the National Board of Health and Welfare and registration of surgical procedures is mandatory by law for all physicians in Sweden. The coverage of NTSRS for the study period 2012-2014 was 75%, 81.4% and 80.7% respectively
- Being tested
- tonsil surgery with or without concomitant adenoidectomy
- Medical subject headings
- Postoperative Complications
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
tonsil surgery with or without concomitant adenoidectomyProcedure or surgery
tonsillectomy, tonsillectomy with adenoidectomy, tonsillotomy, tonsillectomy with adenoidectomy
What is being measured
The primary outcome is the main question the study is designed to answer.
Patient reported symptom relief
The final questionnaire that is sent to the second patient/caregiver questionnaire asks for perceived symptom relief after 180 days by choosing one alternative of four statements: My symptoms are gone / My symptoms are almost gone / My symptoms have not disappeared/ My symptoms have worsened.
Measured: 6 months postoperative report
Secondary outcomes (1)
Patient reported postoperative bleeding
The first patient/caregiver form contains several questions mainly regarding postoperative complications. Any contact with healthcare provider due to postoperative bleeding/pain/infection as well as consequences of the contact; prescribed antibiotics and readmission/return to theatre are reported. Conformity between preoperative information and actual patient experience was is also included in this form.
Measured: 30 days postoperative report
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted12 Jul 2016 (estimated)
- Study startMay 2009
- Primary completion1 Mar 2012
- Study completionDec 2019 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (16)Papers the sponsor has linked to this study.
- Other trials for TonsillectomyStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 11,000 participants (estimated)
- Target duration
- 6 Months
Sponsor and investigators
- Lead sponsor
- Joacim Stalfors
- Sponsor type
- University, hospital or other
- Collaborators
- Swedish Association of Local Authorities and Regions, Sahlgrenska University Hospital, Karolinska Institutet, Linkoeping University, Region Örebro County
- Responsible party
- Sponsor-investigator, Joacim Stalfors, National Tonsil Surgery Register in Sweden
- Investigators
- Joacim Stalfors, MD, PhD, Study director, Sahlgrenska Academy
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02829515
- Sponsor's protocol ID
- 1111
- Acronym
- NTSRS
- Status last verified
- Mar 2018
- First submitted
- 8 Jul 2016
- Last updated
- 30 Mar 2018
- Results posted
- No
- Data monitoring committee
- Yes
- Individual data sharing
- Yes: All registered data i available online for registrating units.
Publications
Odhagen E, Sunnergren O, Hemlin C, Hessen Soderman AC, Ericsson E, Stalfors J. Risk of reoperation after tonsillotomy versus tonsillectomy: a population-based cohort study. Eur Arch Otorhinolaryngol. 2016 Oct;273(10):3263-8. doi: 10.1007/s00405-015-3871-7. Epub 2016 Jan 4.
PubMed 26728487Gerhardsson H, Stalfors J, Odhagen E, Sunnergren O. Pediatric adenoid surgery in Sweden 2004-2013: Incidence, indications and concomitant surgical procedures. Int J Pediatr Otorhinolaryngol. 2016 Aug;87:61-6. doi: 10.1016/j.ijporl.2016.05.020. Epub 2016 May 20.
PubMed 27368444Ostvoll E, Sunnergren O, Ericsson E, Hemlin C, Hultcrantz E, Odhagen E, Stalfors J. Mortality after tonsil surgery, a population study, covering eight years and 82,527 operations in Sweden. Eur Arch Otorhinolaryngol. 2015 Mar;272(3):737-43. doi: 10.1007/s00405-014-3312-z. Epub 2014 Oct 2.
PubMed 25274044Ostvoll E, Sunnergren O, Stalfors J. Increasing Readmission Rates for Hemorrhage after Tonsil Surgery: A Longitudinal (26 Years) National Study. Otolaryngol Head Neck Surg. 2018 Jan;158(1):167-176. doi: 10.1177/0194599817725680. Epub 2017 Aug 22.
PubMed 28828912Sunnergren O, Odhagen E, Stalfors J. Incidence of second surgery following pediatric adenotonsillar surgery: a population-based cohort study. Eur Arch Otorhinolaryngol. 2017 Jul;274(7):2945-2951. doi: 10.1007/s00405-017-4543-6. Epub 2017 Mar 23.
PubMed 28337533Borgstrom A, Nerfeldt P, Friberg D, Sunnergren O, Stalfors J. Trends and changes in paediatric tonsil surgery in Sweden 1987-2013: a population-based cohort study. BMJ Open. 2017 Jan 13;7(1):e013346. doi: 10.1136/bmjopen-2016-013346.
PubMed 28087550Elinder K, Soderman AC, Stalfors J, Knutsson J. Factors influencing morbidity after paediatric tonsillectomy: a study of 18,712 patients in the National Tonsil Surgery Register in Sweden. Eur Arch Otorhinolaryngol. 2016 Aug;273(8):2249-56. doi: 10.1007/s00405-016-4001-x. Epub 2016 Mar 28.
PubMed 27020269Soderman AC, Odhagen E, Ericsson E, Hemlin C, Hultcrantz E, Sunnergren O, Stalfors J. Post-tonsillectomy haemorrhage rates are related to technique for dissection and for haemostasis. An analysis of 15734 patients in the National Tonsil Surgery Register in Sweden. Clin Otolaryngol. 2015 Jun;40(3):248-54. doi: 10.1111/coa.12361.
PubMed 25515059Sunnergren O, Hemlin C, Ericsson E, Hessen-Soderman AC, Hultcrantz E, Odhagen E, Stalfors J. Radiofrequency tonsillotomy in Sweden 2009-2012. Eur Arch Otorhinolaryngol. 2014 Jun;271(6):1823-7. doi: 10.1007/s00405-013-2867-4. Epub 2013 Dec 24.
PubMed 24366615Hultcrantz E, Ericsson E, Hemlin C, Hessen-Soderman AC, Roos K, Sunnergren O, Stalfors J. Paradigm shift in Sweden from tonsillectomy to tonsillotomy for children with upper airway obstructive symptoms due to tonsillar hypertrophy. Eur Arch Otorhinolaryngol. 2013 Sep;270(9):2531-6. doi: 10.1007/s00405-013-2374-7. Epub 2013 Feb 6.
PubMed 23385384Stalfors J, Ericsson E, Hemlin C, Hultcrantz E, Mansson I, Roos K, Hessen Soderman AC. Tonsil surgery efficiently relieves symptoms: analysis of 54 696 patients in the National Tonsil Surgery Register in Sweden. Acta Otolaryngol. 2012 May;132(5):533-9. doi: 10.3109/00016489.2011.644252. Epub 2012 Jan 11.
PubMed 22235871Hessen Soderman AC, Ericsson E, Hemlin C, Hultcrantz E, Mansson I, Roos K, Stalfors J. Reduced risk of primary postoperative hemorrhage after tonsil surgery in Sweden: results from the National Tonsil Surgery Register in Sweden covering more than 10 years and 54,696 operations. Laryngoscope. 2011 Nov;121(11):2322-6. doi: 10.1002/lary.22179. Epub 2011 Oct 12.
PubMed 21994191Odhagen E, Sunnergren O, Soderman AH, Thor J, Stalfors J. Reducing post-tonsillectomy haemorrhage rates through a quality improvement project using a Swedish National quality register: a case study. Eur Arch Otorhinolaryngol. 2018 Jun;275(6):1631-1639. doi: 10.1007/s00405-018-4942-3. Epub 2018 Mar 24.
PubMed 29574597Alm F, Stalfors J, Nerfeldt P, Ericsson E. Patient reported pain-related outcome measures after tonsil surgery: an analysis of 32,225 children from the National Tonsil Surgery Register in Sweden 2009-2016. Eur Arch Otorhinolaryngol. 2017 Oct;274(10):3711-3722. doi: 10.1007/s00405-017-4679-4. Epub 2017 Aug 16.
PubMed 28815308Hallenstal N, Sunnergren O, Ericsson E, Hemlin C, Hessen Soderman AC, Nerfeldt P, Odhagen E, Ryding M, Stalfors J. Tonsil surgery in Sweden 2013-2015. Indications, surgical methods and patient-reported outcomes from the National Tonsil Surgery Register. Acta Otolaryngol. 2017 Oct;137(10):1096-1103. doi: 10.1080/00016489.2017.1327122. Epub 2017 Jun 9.
PubMed 28598766
Study at a glance
From the registry record, last updated by the sponsor on 30 Mar 2018. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- The National Tonsil Surgery Register in Sweden
- ClinicalTrials.gov ID
- NCT02829515
- Acronym / sponsor ID
- NTSRS / 1111
- Study type
- Observational
- Recruitment status
- Unknown status
- Enrolment
- 11,000 participants (estimated)
- Lead sponsor
- Joacim StalforsUniversity, hospital or other
- Collaborators
- Swedish Association of Local Authorities and Regions, Sahlgrenska University Hospital, Karolinska Institutet, Linkoeping University, Region Örebro County
- Study start
- May 2009 (actual)
- Primary completion
- 1 Mar 2012 (actual)
- Study completion
- Dec 2019 (estimated)
- First posted
- 12 Jul 2016 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
For the purpose of quality assurance, the Swedish Association for Otorhinolaryngology and Head and Neck surgery has developed several national registers concerning ear, nose and throat care. One of these is the National Tonsil Surgery Registry in Sweden (NTSRS). In NTSRS patients undergoing tonsil surgery for benign indications are included. Data regarding indication, surgical methods and techniques as well as patient reported outcomes measures are collected. The register is designed to facilitate description of clinical activities in a unit and help identify the need of clinical improvement programs. By compiling national data, the register can be used to describe clinical practice in a large national cohort.
Detailed description
The National Tonsil Surgery Register in Sweden (NTSRS), started in 1997 as one among several registers, aimed to reinforce quality in the Swedish health care and were revised 2009. Data in the NTSRS are collected through four questionnaires; two are filled in by the ENT-surgeon and two postoperative forms, filled in by the patient or the legal guardian, collecting patient related outcome measures (PROM) 30 respective 180 days after surgery.
In the first surgeon questionnaire age, sex, social security number and indication for surgery (upper airway obstruction, recurrent tonsillitis, chronic tonsillitis, peritonsillar abscess, and systemic complications because of tonsillitis or other) are recorded. This is filled in when surgery is notified.
The second surgeon questionnaire records surgical method (TE, TEA, TT or TTA), surgical instruments used for dissection (cold steel, radiofrequency, diathermy scissors, ultracision or other) and hemostasis method used (injection with epinephrine, unipolar diathermy, bipolar diathermy, ties, suture ligature, radiofrequency, other or "none other than compression with packs"). The questionnaire also records information regarding daycare/inpatient procedure and primary postoperative bleeding. Due to the configuration of the questionnaires and the ambition to cover both inpatient and daycare procedures, primary bleeding is defined as bleeding during hospitalization.
The first patient/caregiver form contains several questions mainly regarding postoperative complications. Any contact with healthcare provider due to postoperative bleeding/pain/infection as well as consequences of the contact; prescribed antibiotics and readmission/return to theatre are reported. Conformity between preoperative information and actual patient experience was is also included in this form.
The final questionnaire that is sent to the second patient/caregiver questionnaire asks for perceived symptom relief after 180 days by choosing one alternative of four statements: My symptoms are gone / My symptoms are almost gone / My symptoms have not disappeared/ My symptoms have worsened.
In order to assess coverage for the NTSRS, data has been matched on an individual level with another national register, the National Patient Register (NPR). The NPR is managed by the National Board of Health and Welfare and registration of surgical procedures is mandatory by law for all physicians in Sweden. The coverage of NTSRS for the study period 2012-2014 was 75%, 81.4% and 80.7% respectively
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
- Target follow-up
- 6 Months
Who may qualify
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Child, Adult, Older adult
- Study population
- All patients undergoing benign tonsil surgery in Sweden
Key inclusion criteria (1 listed)
- All patients undergoing benign tonsil surgery in Sweden
Key exclusion criteria (1 listed)
- All patients operated with an C- or D0-48 ICD 10 code, indicating not benign diagnoses
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| tonsil surgery with or without concomitant adenoidectomytonsillectomy, tonsillectomy with adenoidectomy, tonsillotomy, tonsillectomy with adenoidectomy | Procedure or surgery | – |
Primary outcome
Patient reported symptom relief
Time frame: 6 months postoperative report
The final questionnaire that is sent to the second patient/caregiver questionnaire asks for perceived symptom relief after 180 days by choosing one alternative of four statements: My symptoms are gone / My symptoms are almost gone / My symptoms have not disappeared/ My symptoms have worsened.
1 secondary outcome
Patient reported postoperative bleeding
Time frame: 30 days postoperative report
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 30 Mar 2018.
- Background: PubMed 26728487Odhagen E, Sunnergren O, Hemlin C, Hessen Soderman AC, Ericsson E, Stalfors J. Risk of reoperation after tonsillotomy versus tonsillectomy: a population-based cohort study. Eur Arch Otorhinolaryngol. 2016 Oct;273(10):3263-8. doi: 10.1007/s00405-015-3871-7. Epub 2016 Jan 4.
- Background: PubMed 27368444Gerhardsson H, Stalfors J, Odhagen E, Sunnergren O. Pediatric adenoid surgery in Sweden 2004-2013: Incidence, indications and concomitant surgical procedures. Int J Pediatr Otorhinolaryngol. 2016 Aug;87:61-6. doi: 10.1016/j.ijporl.2016.05.020. Epub 2016 May 20.
- Background: PubMed 25274044Ostvoll E, Sunnergren O, Ericsson E, Hemlin C, Hultcrantz E, Odhagen E, Stalfors J. Mortality after tonsil surgery, a population study, covering eight years and 82,527 operations in Sweden. Eur Arch Otorhinolaryngol. 2015 Mar;272(3):737-43. doi: 10.1007/s00405-014-3312-z. Epub 2014 Oct 2.
- Background: PubMed 28828912Ostvoll E, Sunnergren O, Stalfors J. Increasing Readmission Rates for Hemorrhage after Tonsil Surgery: A Longitudinal (26 Years) National Study. Otolaryngol Head Neck Surg. 2018 Jan;158(1):167-176. doi: 10.1177/0194599817725680. Epub 2017 Aug 22.
- Background: PubMed 28337533Sunnergren O, Odhagen E, Stalfors J. Incidence of second surgery following pediatric adenotonsillar surgery: a population-based cohort study. Eur Arch Otorhinolaryngol. 2017 Jul;274(7):2945-2951. doi: 10.1007/s00405-017-4543-6. Epub 2017 Mar 23.
- Background: PubMed 28087550Borgstrom A, Nerfeldt P, Friberg D, Sunnergren O, Stalfors J. Trends and changes in paediatric tonsil surgery in Sweden 1987-2013: a population-based cohort study. BMJ Open. 2017 Jan 13;7(1):e013346. doi: 10.1136/bmjopen-2016-013346.
- Results publication: PubMed 27020269Elinder K, Soderman AC, Stalfors J, Knutsson J. Factors influencing morbidity after paediatric tonsillectomy: a study of 18,712 patients in the National Tonsil Surgery Register in Sweden. Eur Arch Otorhinolaryngol. 2016 Aug;273(8):2249-56. doi: 10.1007/s00405-016-4001-x. Epub 2016 Mar 28.
- Results publication: PubMed 25515059Soderman AC, Odhagen E, Ericsson E, Hemlin C, Hultcrantz E, Sunnergren O, Stalfors J. Post-tonsillectomy haemorrhage rates are related to technique for dissection and for haemostasis. An analysis of 15734 patients in the National Tonsil Surgery Register in Sweden. Clin Otolaryngol. 2015 Jun;40(3):248-54. doi: 10.1111/coa.12361.
- Results publication: PubMed 24366615Sunnergren O, Hemlin C, Ericsson E, Hessen-Soderman AC, Hultcrantz E, Odhagen E, Stalfors J. Radiofrequency tonsillotomy in Sweden 2009-2012. Eur Arch Otorhinolaryngol. 2014 Jun;271(6):1823-7. doi: 10.1007/s00405-013-2867-4. Epub 2013 Dec 24.
- Results publication: PubMed 23385384Hultcrantz E, Ericsson E, Hemlin C, Hessen-Soderman AC, Roos K, Sunnergren O, Stalfors J. Paradigm shift in Sweden from tonsillectomy to tonsillotomy for children with upper airway obstructive symptoms due to tonsillar hypertrophy. Eur Arch Otorhinolaryngol. 2013 Sep;270(9):2531-6. doi: 10.1007/s00405-013-2374-7. Epub 2013 Feb 6.
- Results publication: PubMed 22235871Stalfors J, Ericsson E, Hemlin C, Hultcrantz E, Mansson I, Roos K, Hessen Soderman AC. Tonsil surgery efficiently relieves symptoms: analysis of 54 696 patients in the National Tonsil Surgery Register in Sweden. Acta Otolaryngol. 2012 May;132(5):533-9. doi: 10.3109/00016489.2011.644252. Epub 2012 Jan 11.
- Results publication: PubMed 21994191Hessen Soderman AC, Ericsson E, Hemlin C, Hultcrantz E, Mansson I, Roos K, Stalfors J. Reduced risk of primary postoperative hemorrhage after tonsil surgery in Sweden: results from the National Tonsil Surgery Register in Sweden covering more than 10 years and 54,696 operations. Laryngoscope. 2011 Nov;121(11):2322-6. doi: 10.1002/lary.22179. Epub 2011 Oct 12.
- Individual participant dataSharing planned: Yes. All registered data i available online for registrating units.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Lisa Hellgård contact
Joacim Stalfors, MD, PhD study director
Sahlgrenska Academy
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Tonsillectomy and Prospective Studies, run by Joacim Stalfors at 1 site in Sweden.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: status not confirmed, as of the sponsor's last update on 30 Mar 2018. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Sweden. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
Contact Joacim Stalfors, MD, PhD (+46736421613, joacim@stalfors.se), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Patient reported symptom relief (time frame: 6 months postoperative report). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT02829515, which also lists 16 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 30 Mar 2018.