Patient injuries from tonsil and adenoid surgery in Finland

Abstract

Objectives
The aims of this national register‐based study were to examine patient injury claims related to tonsil and adenoid surgery injuries and to compare the frequency of claims between tonsillectomies and tonsillotomies in Finland.

Methods
We analyzed the complaints related to tonsil and adenoid surgery received by the Finnish Patient Insurance Center (PIC) between the years 2000 and 2019. One hundred seventy‐two cases were included in the analysis. The annual surgery rates between the years 2000 and 2018 were acquired from the Finnish Institute for Health and Welfare.

Results
During the years 2000 to 2018, a total of 292,679 patients had tonsil and/or adenoid surgery nationwide. For tonsil or adenoid surgeries, the national average was 5.3 cases and 1.8 cases per 10,000, respectively, resulting in patient injury claims and compensations. A total of 33.1% of the claims regarding tonsil or adenoid surgery processed by the PIC were compensated. Most of the claims were made after a tonsillectomy (87.8%), and few were made after a tonsillotomy (1.7%). Seven deaths were recorded.

Conclusion
Patient injuries from tonsil and adenoid surgeries were mostly related to traditional extracapsular tonsillectomies. Most surgeries, along with most complications, involved specialists, who performed routine operations in high‐volume centers. Surgeries for acute or recurrent infections resulted in more claims. Severe complications arising from tonsil and adenoid surgeries were rare.

Level of Evidence
4.

Full text

ORIGINAL RESEARCH
Patient injuries from tonsil and adenoid surgery in Finland
Henrik M. Sjöblom MD
1,2
| Jaakko M. Timgren MD
2
|
Jaakko M. Piitulainen MD, PhD
1,2
| Jussi Jero MD, PhD
3
1
Division of Surgery and Cancer Diseases,
Department of Otorhinolaryngology –Head
and Neck Surgery, Turku University Hospital,
Turku, Finland
2
Department of Medicine, University of Turku,
Turku, Finland
3
Department of Medicine, University of
Helsinki, Helsinki, Finland
Correspondence
Henrik M. Sjöblom, Department of
Otorhinolaryngology –Head and Neck
Surgery, Turku University Hospital, PO
52, 20521 Turku, Finland.
Email: hmsjob@utu.fi
Funding information
Suomen Lääketieteen Säätiö; Turun
Yliopistollisen Keskussairaalan Koulutus- ja
Tutkimussäätiö
Abstract
Objectives: The aims of this national register-based study were to examine patient
injury claims related to tonsil and adenoid surgery injuries and to compare the
frequency of claims between tonsillectomies and tonsillotomies in Finland.
Methods: We analyzed the complaints related to tonsil and adenoid surgery received
by the Finnish Patient Insurance Center (PIC) between the years 2000 and 2019.
One hundred seventy-two cases were included in the analysis. The annual surgery
rates between the years 2000 and 2018 were acquired from the Finnish Institute for
Health and Welfare.
Results: During the years 2000 to 2018, a total of 292,679 patients had tonsil and/or
adenoid surgery nationwide. For tonsil or adenoid surgeries, the national average
was 5.3 cases and 1.8 cases per 10,000, respectively, resulting in patient injury claims
and compensations. A total of 33.1% of the claims regarding tonsil or adenoid surgery
processed by the PIC were compensated. Most of the claims were made after a
tonsillectomy (87.8%), and few were made after a tonsillotomy (1.7%). Seven deaths
were recorded.
Conclusion: Patient injuries from tonsil and adenoid surgeries were mostly related to
traditional extracapsular tonsillectomies. Most surgeries, along with most complica-
tions, involved specialists, who performed routine operations in high-volume centers.
Surgeries for acute or recurrent infections resulted in more claims. Severe complica-
tions arising from tonsil and adenoid surgeries were rare.
Level of Evidence: 4.
KEYWORDS
adenoidectomy, patient injuries, tonsillectomy
1|INTRODUCTION
Most of the errors and adverse events in the field of otorhinolaryngology
(ORL) are related to surgical treatment.
1
Retrospective national studies in
Finland show that ORL-related patient injuries, in general, are strongly
linked to routine operations in high-volume centers.
2–5
In a recent study,
88% of ORL-related patient injuries that affected children were related
to operative care in Finland.
3
All patients treated by public or private health care professionals
in Finland are insured by the Finnish Patient Insurance Center (PIC),
Henrik M. Sjöblom and Jaakko M. Timgren contributed equally to this study.
Received: 2 March 2022 Revised: 11 August 2022 Accepted: 1 October 2022
DOI: 10.1002/lio2.954
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any
medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
© 2022 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.
Laryngoscope Investigative Otolaryngology. 2022;7:1773–1779. wileyonlinelibrary.com/journal/lio2 1773

which processes all the claims made due to personal injuries in the
health care sector in Finland. Patient injuries are compensated for by
the PIC in accordance with the Patient Injuries Act (Potilasvahinkolaki
585/1986). Patients, who have sustained an injury or have experi-
enced an unreasonable delay of treatment that has had an effect on
the outcome of the injury, can apply for compensation from the PIC.
6
Tonsil and adenoid surgeries are among the most frequently per-
formed types of ORL surgeries. During recent decades, partial removal
of the tonsils has become a notable alternative to traditional extracap-
sular tonsillectomy, especially when the indication for surgery is
hypertrophy. The efficacy of tonsillotomy and tonsillectomy has been
studied in pediatric and adolescent populations.
7
Tonsillotomy is
associated with less postoperative pain
8,9
and bleeding.
10
In recent
systematic reviews on adult populations, there was no significant dif-
ference in the efficacy between the methods, however, there was a
significant difference in postoperative pain, use of analgesics, and the
amount of secondary postoperative hemorrhages (PTHs) in favor of
tonsillotomy.
11,12
However, the risk of reoperation has been reported
to be up to seven times higher after tonsillotomy compared to tonsil-
lectomy in the youngest age group.
13
A tonsillectomy and a tonsillot-
omy have similar postoperative morbidities. The most common are
hemorrhage, pain, infections, and dehydration.
14
PTHs can be graded
according to the severity as: Grade I being minor hemorrhage that
stopped without intervention, Grade II being a required compression
or electrocautery with local anesthesia, and Grade III being a required
intervention under general anesthesia.
15,16
It is worth noting that PTH
grading may also be reflective of institutional practices. For example, a
PTH in a child may be more commonly treated under general anesthe-
sia, which consequently increases the grade.
The aim of this study was to examine the Finnish patient injuries
related to tonsil and adenoid surgery and to compare the frequency of
injuries between tonsillectomies and tonsillotomies. We were also
interested in whether the number of compensated cases had
decreased from the early 2000s, as the World Health Organization
(WHO) surgical checklist was implemented nationally around the year
2010.
2
Our hypothesis was that tonsillotomies result in fewer claims
than tonsillectomies.
2|MATERIALS AND METHODS
In this study, we analyzed all the complaints related to tonsil and adenoid
surgery that were received by the PIC between the years 2000–2019.
All the claims with the Nordic classification codes for tonsillectomy
(EMB10), tonsillotomy (EMB15), adenotonsillectomy (EMB20), and ade-
noidectomy (EMB30) were collected from the PIC records. All 172 cases
were included in the analysis. The STROBE checklist was followed when
drafting the manuscript.
The materials from the PIC consisted of medical records, experts'
assessments, and indemnity decisions. These materials were reviewed
to collect the following information: compensation status, classifica-
tion code, the year of operation, the operative unit, and primary and
secondary injuries. The injuries were distributed into 13 categories
(Table 1). PTHs were recorded separately. We graded PTHs according
to the severity with the grading criteria described in the Introduction
with Grade I being minor hemorrhage that stopped without interven-
tion, Grade II being a required compression or electrocautery with
local anesthesia, and Grade III being a required intervention under
general anesthesia.
The patient background data are listed in Table 2. From the oper-
ative reports, we collected the following data: surgical technique, sur-
geons' level of training, the duration of the operation, and whether
TABLE 1 Number and proportion (%) of the main compensated patient injury between two different surgical indications.
Main compensated patient injury
Hypertrophy Infections
All claims Compensated All claims Compensated
Problems related to altered anatomy of the pharynx 5 (10.6%) 2 (9.1%) 23 (19.5%) 5 (15.2%)
Postsurgery hemorrhage 8 (17.0%) 15 (12.7%) 1 (3.0%)
Nerve injury 1 (2.1%) 1 (4.5%) 21 (17.8%) 7 (21.2%)
Burn injury 8 (17.0%) 7 (31.8%) 10 (8.5%) 7 (21.2%)
Infection 7 (14.9%) 4 (18.2%) 9 (7.6%) 1 (3.0%)
Damage to adjacent anatomical structure 2 (4.3%) 16 (13.6%) 5 (15.2%)
Tonsil remnant (reoperation) 1 (2.1%) 6 (5.1%) 3 (9.1%)
Death 4 (8.5%) 4 (18.1%) 3 (2.5%) 3 (9.1%)
Impaired taste 1 (2.1%) 5 (4.2%)
Retained surgical bodies 3 (6.4%) 2 (9.1%) 1 (0.8%)
Complication of anesthesia 1 (2.1%) 1 (4.5%) 3 (2.5%) 1 (3.0%)
Excessive intraoperative bleeding 3 (6.4%) 1 (4.5%) 1 (0.8%)
Other 3 (6.4%) 5 (4.2%)
Total 47 22 108 33
Note: The two compensations that were uncategorizable were a burn injury and an infection.
1774 SJÖBLOM ET AL.

the operation was performed during office hours. We also recorded
whether the injury led to any extra visits to an outpatient clinic or
the emergency department, an admission to inpatient care, or
reoperation.
The annual rates of tonsil and adenoid surgeries in Finland,
excluding the year 2019, were acquired from the Finnish Institute for
Health and Welfare. Data from the years 2000 to 2018 included the
Nordic classification codes, gender, age, and diagnosis code (WHO
classification of diseases [ICD-10]) of the patients and annual opera-
tion rates of the individual health care institutes in Finland.
For data collection, we used Microsoft Excel (Version 16.40;
Microsoft Corporation). For statistical analyses, we used JMP Pro
14 (Version 14.2; SAS Institute Inc.), and descriptive figures and tables
were created with Microsoft PowerPoint (Version 16.42; Microsoft
Corporation). The data that support the findings of this study are
available from the corresponding author upon reasonable request.
Data are described in terms of frequencies and proportions for
categorical data and means and standard deviations for continuous
data. The counts of events were analyzed using either Poisson or neg-
ative binomial (NB) regression using the total amount of procedures
as an offset parameter. The model fit between the Poisson and NB
models was checked using a Vuong's test.
In Finland, retrospective, register-based studies do not require
institutional review boards' approval, and for that reason, an approval
from the ethical committee was not applied. The data search and the
study protocol were approved by the PIC and the Finnish Institute for
Health and Welfare.
3|RESULTS
In 2019, the population of Finland was 5.53 million.
17
During the
years 2000 to 2018, a total of 292,679 patients had tonsil and/or ade-
noid surgery nationwide. The overall rate has declined due to the
decline in adenoidectomies (Figure 1), but the rate of tonsil surgery
has remained steady. Figure 2shows the volume of operations at
different hospital levels.
During the years 2000–2019, a total of 172 claims regarding
tonsil or adenoid surgery were processed by the PIC. Fifty-seven of
these (33.1%) were compensated. Most of the claims were made after
a tonsillectomy (n=151, 87.8%), some after adenoidectomy (n=18,
10.5%), and very few after tonsillotomy (n=3, 1.7%).
0
2000
4000
6000
8000
10000
12000
14000
16000
ADENOID AND TONSIL SURGERY IN
FINLAND
ADENOIDECTOMY TONSILLECTOMY TONSILLOTOMY
FIGURE 1 Tonsil and/or adenoid surgery
rates nationwide during the years 2000–2018.
TABLE 2 Patient background data: all claimants recorded (all), and
those who received compensation (compensated).
All Compensated
Number of adults 119 39
Age of adults Mean =36.4 (16–73) Mean =35.3 (16–73)
Sex of adults 34.5% male 35.9% male
Smoking 17.6% 7.7%
Body mass index Mean =25.02 Mean =24.22
Number of children 53 18
Age of children Mean =6.7 (1–15) Mean =6.9 (1–15)
Sex of children 54.7% male 66.7% male
Iso-BMI
a
Mean =23.52 Mean =24.48
a
Age-adjusted body mass index (equivalent to adult values, i.e., >25 is the
definition of overweight and >30 obese). Sufficient data to calculate were
available for 34 (all) and 14 (compensated) children.
SJÖBLOM ET AL.1775

As the processed claims included operations from years 1996 to
2019, we chose to analyze data from years that we also had national
surgery statistic data (2000–2018). Of the total claims in our data,
156 claims were made for patients operated on during the years 2000
to 2018. Fifty-four of these (34.6%) were compensated. This amounts
to an average of 5.3 cases per 10,000 tonsil or adenoid surgeries
resulting in a claim and 1.8 per 10,000 resulting in compensation.
Figure 3shows the number of claims and compensations per 10,000
operations for the years for which we had national surgery data
available. The average was 8.7 claims per 10,000 surgeries for tonsil-
lectomies, 1.3 for adenoidectomies, and 4.4 for tonsillotomies.
Cases are processed and compensated for according to the Finn-
ish Tort Liability Act (Vahingonkorvauslaki 412/1974). A patient injury
claim can be accepted as a true injury, but a patient might still not be
compensated. The average compensation for accepted claims in our
data was EUR 2358.
All the surgeries were performed by either a specialist (72.7%) or
a resident in ORL. When analyzing both the total amount of claims
FIGURE 2 Volumes of operations at different
hospital levels. Primary care <100 operations per
year, and therefore are not visible. Different
hospital levels are represented by bars. The total
amount operated nationally is represented by a
solid line.
FIGURE 3 The number of claims and
compensations nationally per 10,000 operations
between the years 2000 and 2018. Compensated
cases from 2018 were most likely still being
processed at the time of data collection, as their
processing time is longer, and we did not
receive any.
1776 SJÖBLOM ET AL.

and only the compensated cases, the professional responsible was
most often a specialist (73.7%/75.0%). Nearly all (94.7%) of the
surgery was done during office hours. A total of 24.6% of patients
who received compensation for injuries were operated on in tertiary
(university) hospitals and 38.6% in secondary (central) hospitals. The
differences among different hospital districts were not statistically
significant.
We divided the indications for surgery into infectious diagnoses,
for example, peritonsillar abscess, acute and recurrent tonsillitis, and
hypertrophic diagnoses, for example, tonsillar hypertrophy, sleep
apnea, and snoring. One hundred sixty-five of the 172 claims could be
classified as either. Three times more claims were made after surgery
for infectious diagnoses than for hypertrophy (Figure 4)(p< .0001),
and the number of compensated injuries was nearly double with 2.98
claims for infectious diagnoses and 1.76 claims for hypertrophy per
10,000 operations (p=.0606). We also sorted claims by surgical tech-
nique. There were five (3.3%) claims where a tonsillectomy was per-
formed by using traditional cold steel dissection. None of these claims
resulted in a compensation. In 50 (33.1%) claims, only electrocautery
was used. In 87 (57.6%) claims, the dissection was performed using
cold instruments, but electrocautery was used for hemostasis. In nine
claims, it was not possible to determine which technique was used.
National data for surgical methods was not available, and the signifi-
cance of these differences cannot thus be further analyzed.
During the years 2017–2018, the average tonsillectomy in
Finland lasted 28.17 min, which did not include anesthesia. For a com-
pensated tonsillectomy-related injury, the mean operating time was
44.91 min (95% confidence interval =10–250 min) in our data.
A total of 91.1% of the compensated patient injuries resulted in
some additional measures with extra visits to the outpatient clinic in
86.0% of these, visits to the ER in 33.3%, and reoperation in 47.4% of
the compensated patient injuries. In 49.1% of compensated injuries,
the patient was admitted to the hospital with an average of 5.6 days
of inpatient care. Twelve compensated patients (21.1%) spent time in
intensive care with an average stay of 5.2 days.
Fifty-five (32.0%) patients, who submitted claims to the PIC, had
PTH. Those with PTH were divided into grades as follows: Grade I,
n=7; Grade II, n=13; and Grade III, n=35. In 25 patients, PTH was
the main complication for which they submitted the patient injury
claim. Only one of these was compensated, as PTH is an expected
complication.
The WHO Surgical Checklist was implemented in Finland gener-
ally around the year 2010. In our data, there were 6.08 claims and
1.85 compensations for every 10,000 operations from 2000 to 2009
and 4.25 claims and 1.75 compensations from 2010 to 2018. The dif-
ference in claims was statistically significant (p=.0331).
We distributed the different types of patient injuries into 13 cate-
gories (Table 1). The most common compensated patient injury was a
burn (26.8%) followed by nerve injury. The most common nerve dam-
aged was the glossopharyngeal nerve. Sixty-one patients (35.5%) had
two or more separate injuries to claim. Table 1also shows the differ-
ent types of compensated injuries divided between two different sur-
gical indications.
The PIC compensates for permanent injury or permanent
cosmetic injury based on the Finnish Tort Liability Act (412/1974).
Fourteen of the 57 patients compensated (24.6%) were given com-
pensation for permanent injury. In our own analysis of the data, 28 of
the 57 compensated had injuries that we ourselves considered perma-
nent (49.1%). Most (76.7% of all claims) of the injuries were detect-
able immediately on the day of surgery. The PIC requires permanent
injuries to reduce the patient's functional capacity permanently
that causes a reduction in their quality of life. We classified perma-
nent cosmetic injuries, for example, large burn marks and scars, as
permanent also.
All seven deaths were compensated for, as even in cases where
the cause was unavoidable, such as PTH, death is an intolerable com-
plication. Five deaths were caused by excessive PTH and the aspira-
tion of blood, and one of these was within 24 h of surgery. One death
was unexplainable even after autopsy, and one was due to inadequate
monitoring after anesthesia. Two of the deceased were children, who
were both under the age of 10. All seven surgeries were routine extra-
capsular tonsillectomies during office hours, and all surgeons were
specialists. According to the Finnish Institute for Health and Welfare,
10 patients died within 21 days of their tonsillectomy during the years
FIGURE 4 The average amount of claims and
compensations classified by surgical indication.
Nationally, the number of surgeries sorted by
diagnosis codes used were received directly from
the Finnish Institute for Health and Welfare.
Indications for the surgeries resulting in claims
were analyzed from patient charts. Seven
operations had multiple or no diagnoses available
and are not listed here
SJÖBLOM ET AL.1777

2008–2018, and none of these deaths were due to adenoidectomies or
tonsillotomies. Earlier data were not available, but based on this informa-
tion, it is likely that not all deaths lead to a patient insurance claim.
4|DISCUSSION
This study supports the hypothesis that most tonsil and adenoid sur-
gery patient injury claims and compensations are related to traditional
extracapsular tonsillectomy. Most complications in tonsil or adenoid
surgery involved specialists in ORL during office hours, who performed
routine operations in high-volume centers. Complications in these
routine operations significantly affected patients. Most of the patients
who received compensations had extra visits to clinics, and half of
those who received compensations required inpatient care. Signifi-
cantly more claims were made after surgery for a diagnosis for infec-
tion. Burn injuries were the most common reason for compensation.
In children, the rate of tonsillectomy-related patient injuries
could be reduced by performing more tonsillotomies or intracapsular
tonsillectomies in relation to traditional tonsillectomies.
18
Based
on recent studies in adults,
12
we hypothesized that their rate of
tonsillectomy-related patient injuries could also be reduced by per-
forming an intracapsular tonsillectomy instead, especially when the
indication for surgery is hypertrophy or obstruction.
Three patient injuries were related to tonsillotomies, of which
one was due to a careless technique causing a burn injury, and two
developed osteomyelitis, a rare complication. The first national tonsil-
lotomies in our data were recorded in 2009 (Figure 1). No patient
injury claims were made during the analyzed period related to hemor-
rhage in tonsillotomy procedures.
Five patients died because of PTH. Generally, the PIC does not
compensate for PTH, and patients are informed that this is a common
complication. Patients can still submit claims to the PIC if they were
not satisfied. Grade III PTHs, requiring GA, are overrepresented in our
data compared to other reports.
16
This might be because patients think
that a PTH that requires general anesthesia to control it is unreason-
able, and this may result in more patient injury claims. It may be benefi-
cial to spend additional time on patient counseling in these cases.
Based on other studies, performing tonsillectomies with a cold steel
dissection technique
19
or performing intracapsular tonsillectomies
instead
11
may help reduce PTHs. The incidence of life-threatening PTH
is higher in children than in adults.
20
PTH should be treated by an oto-
rhinolaryngologist, but sometimes primary care might be the first to
treat these patients in emergencies. In rural areas, treatment should
consist of compression, and if compression is unable to stop the bleed-
ing, the patient should be transported to an institution where an otorhi-
nolaryngologist is available.
Burn injury is a known possible complication when using electro-
cautery.
21
The most common reason for a compensation in a claim
was a burn injury, and some form of electrocautery was used in 92.9%
of compensated claims. Most of the burns were on the right side of
the mouth, presumably because the surgeons were right-handed. A
longer operating time was seen in compensated cases in comparison
to the national average. This might be because intraoperative compli-
cations, which resulted in patient injuries, may lengthen operations,
but we cannot conclude causality from our data.
The national rate of adenoidectomies fell rapidly during the early
2000s (Figure 1) after a national recommendation was released that
did not support the role of adenoidectomy for a primary indication of
recurrent otitis media.
In patients who underwent surgery for acute or chronic infections,
they were 79.8% more likely to receive compensation than those oper-
ated on for hypertrophy, and the number of claims was threefold.
Figure 4shows the rates per 10,000 operations for the years 2000–
2018. We speculate that this difference may be due to the adhesions
and scarring after recurrent infections and, in part, due to operating on
acutely inflamed tonsils, both of which increase surgical difficulty.
A previous study of Finnish patient injury compensations in otolaryn-
gology supported the role of a checklist intervention in preventing errors.
2
In our data, there were 6.08 claims and 1.85 compensations for every
10,000 operations before the national implementation of the WHO Surgi-
cal Checklist and 4.25 claims and 1.75 compensations after. The slight, but
statistically significant, reduction in claims may, in part, be due to check-
lists. Interestingly, a slight increase was noted in the amount of retained
surgical packing before and after the implementation of the checklist.
Although every patient treated by an official health care provider
in Finland is insured by the PIC, it is likely that not all eligible patients
submit claims. The overall incidence of injuries is therefore likely to be
greater than reported. The type of insurance policy also affects the
type of injuries that are compensated. All the claims are reviewed by
medical experts of the PIC, and in most cases, a consultation from a
senior otorhinolaryngologist is requested. The opinion of the reviewer
or the consultant can, in some borderline cases, affect the result.
Nonetheless, we believe our results are generalizable.
As always with retrospectively collected data, we are dependent
on chart records. It is possible that not all comorbidities are included
in the records. In some cases, data about the duration that the patient
had suffered from the complications were not retrievable due to
incomplete documents. Some variances in the use of classification
codes in Finnish hospitals are possible (i.e., EMB10 used instead of
EMB15 for tonsillotomy).
The PIC has a processing time of up to 3 years from the arrival of
the application and may have caused incomplete data analysis. As some
of the claims processed in the early 2000s were from operations as far
back as 1996, it is likely that our data from recent years are missing
some cases that are still being processed or patients have not made
claims for it yet.
Severe complications are rare in tonsil surgery, and more data are
needed to make definite conclusions on factors leading to serious
patient injuries.
5|CONCLUSION
Patient injury insurance claims in tonsil and adenoid surgery
were mainly related to the traditional extracapsular tonsillectomy.
1778 SJÖBLOM ET AL.

Most claims in tonsil or adenoid surgery involved specialists in ORL
during office hours, who performed routine operations in high-volume
centers. Patient injury claims were more common when operating for
infections than adenotonsillar hypertrophy. Severe complications in
tonsil and adenoid surgery were rare. Future studies may consider
looking at similar statistics in different countries to understand if
these trends are consistent globally.
AUTHOR CONTRIBUTIONS
Henrik M. Sjöblom and Jaakko M. Timgren acquired and analyzed the
data. Henrik M. Sjöblom and Jaakko M. Timgren drafted the manu-
script. Henrik M. Sjöblom, Jaakko M. Timgren, Jaakko M. Piitulainen,
and Jussi Jero designed the work, revised and approved the manu-
script, and agree to be accountable for all aspects of the work.
ACKNOWLEDGMENTS
The authors wish to thank Tommi Kauko, MSc for his help in conduct-
ing the statistical analysis and Robert M. Badeau, MSc, PhD, of Aura
Professional English Consulting (www.auraenglish.com) for providing
the English language checking service. This study was supported by
grants from Turku University Hospital Foundation for Education and
Research and The Finnish Medical Foundation.
CONFLICT OF INTEREST
The authors declare no conflict of interest.
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the
corresponding author upon reasonable request.
ORCID
Henrik M. Sjöblom https://orcid.org/0000-0001-6582-7699
Jaakko M. Timgren https://orcid.org/0000-0002-7573-4274
Jaakko M. Piitulainen https://orcid.org/0000-0001-9788-8904
Jussi Jero https://orcid.org/0000-0002-1945-4008
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How to cite this article: Sjöblom HM, Timgren JM,
Piitulainen JM, Jero J. Patient injuries from tonsil and adenoid
surgery in Finland. Laryngoscope Investigative Otolaryngology.
2022;7(6):1773‐1779. doi:10.1002/lio2.954
SJÖBLOM ET AL.1779