Impact of NICE guidance on rates of haemorrhage after tonsillectomy: an evaluation of guidance issued during an ongoing national tonsillectomy audit
Impact of NICE guidance on rates of haemorrhage after tonsillectomy: an evaluation of guidance issued during an ongoing national tonsillectomy audit
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DOI：
10.1136/qshc.2006.021386
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发表时间：
2008-08-01
影响因子：
--
通讯作者：
van der Meulen (chair), J.
中科院分区：
文献类型：
--
作者：
Brown, P.;Ryan, R.;van der Meulen (chair), J.
背景资料：国家卫生和临床优化研究所（NICE）在国家审计手术实践和术后并发症期间发布了扁桃体切除术手术技术指南。目的：评估该指南对扁桃体切除术实践和结果的影响。设计：对常规收集的医院流行病学统计数据进行中断的时间序列分析，以及使用国家前瞻性扁桃体切除术审计数据对手术技术的纵向趋势进行分析。参与者：2002年1月至2004年12月期间在英国NHS医院接受扁桃体切除术的患者。主要结果测量：结果：从2002年开始，出血率每年增加0.5%，指南发布时达到6.4%。发表后，出血率立即下降至5.7%（差异0.7%：95% CI-1.3%至0.0%），并且增加率似乎已经停止。从国家前瞻性扁桃体切除术审计的数据显示，秋天正好在手术技术的转变，这是一致的guidance.Conclusion：尼斯指导影响扁桃体切除术的手术技术，反过来又产生了立即下降，术后出血。正在进行的国家审计和外科专家协会的大力支持可能有助于其实施。
Background: The National Institute for Health and Clinical Excellence (NICE) issued guidance on surgical techniques for tonsillectomy during a national audit of surgical practice and postoperative complications.Objective: To assess the impact of the guidance on tonsillectomy practice and outcomes.Design: An interrupted time-series analysis of routinely collected Hospital Episodes Statistics data, and an analysis of longitudinal trends in surgical technique using data from the National Prospective Tonsillectomy Audit.Participants: Patients undergoing tonsillectomy in English NHS hospitals between January 2002 and December 2004.Main outcome measure: Postoperative haemorrhage within 28 days.Results: The rate of haemorrhage increased by 0.5% per year from 2002, reaching 6.4% when the guidance was published. After publication, the rate of haemorrhage fell immediately to 5.7% (difference 0.7%: 95% Cl -1.3% to 0.0%) and the rate of increase appeared to have stopped. Data from the National Prospective Tonsillectomy Audit showed that the fall coincided with a shift in surgical techniques, which was consistent with the guidance.Conclusion: NICE guidance influenced surgical tonsillectomy technique and in turn produced an immediate fall in postoperative haemorrhage. The ongoing national audit and strong support from the surgical specialist association may have aided its implementation.