Great differences in almond operations in children

Large regional differences in frequency of tonsillitis surgery in children

07/05/2013

Almond surgery in children is one of the most common inpatient procedures under general anesthesia. In 2010, around 69,000 children and adolescents up to the age of 19 were removed from the palatine tonsils. In a regional comparison commissioned by Bertelsmann, the „However, there are marked differences in the number of health checks that could be the cause of the decision: for example, while 27 out of every 10,000 children in Berlin lost their tonsils, Bremen had 76 children.

Residence decides on tonsil surgery in children
Many children often have sore throat, snore and wheeze. The result: the almonds must go out. Whether this decision is always the best, the study presents „Fact check health“ on behalf of Bertelsmann in question. In a regional comparison shows that the frequency of almond OPs depends in part strongly on the place of residence. The evaluation of hospital registries and data of the Federal Statistical Office showed that in some regions only every 900th child removes the palatine tonsils, while in other regions it is every 70th. Apparently, not only medical facts count in the decision but also often local views of doctors ... Last but probably also the supply situation and economic factors influence. So far there are no binding guidelines for tonsillectomy in Germany (removal of the palatine tonsils).

Nearly 60 percent of almond surgery in children is due to recurrent tonsillitis. Another third of the interventions are due to enlarged palatine tonsils. „There is hardly any surgery that relies so much on the experience of the doctor and the assessment of the discomfort of his patients, "said Jochen Windfuhr, an otorhinolaryngologist, who acted as consultant for the study Remedying tonsillitis as well as enlarged tonsils may help to remove the troublemakers for a short time, but doctors, parents and children should not overlook the risks of the procedure, as general anesthesia and possible rebleeding can sometimes pose life-threatening hazards. „Many patients and many doctors who are not specialized in ear, nose and throat medicine, it is not always clear what consequences the operation can have, "said Windfuhr, who works in the clinics Maria Hilf in Mönchengladbach.

When are almond operations necessary in children??
According to the Bertelsmann study, the decision to have tonsillitis due to chronic inflammation was twelve times more common in some circles than in others. Enlarged palatine tonsils were operated up to 58 times more frequently even in some regions. „The data shows that children are likely to be operated on too often in some regions. In other regions, on the other hand, the procedure will not be effective, even if justified, "said Frank Waldfahrer, senior consultant at the ENT Clinic in Erlangen „mirror“. One of the causes of the serious differences is probably due to the sometimes strongly divergent supply structures. The study showed that the least amount of surgery was performed in regions without an ENT department. In areas with large departments for ENT diseases, on the other hand, an above-average number of operations were performed.

In many small departments, almond operations are the core business. The study found that in 175 out of 673 departments, more than half of the operations consisted of tonsillectomies in 2010, and in 71 they even accounted for more than two thirds of the interventions „Fact check health“ it says about the economic aspects of almond operations: „All in all, the health insurance companies reimburse around € 150 million a year for the inpatient removal of palatine tonsils.“ Although a reduction in the number of tonsils could save a few million euros, the amount would be negligible compared to the total expenditure of hospitals. „However, the economic importance of palatine tonsil removal is high for most ENT departments. The operation is a mostly predictable performance and is performed on every fifth inpatient case of the ENT department“, says in a statement to the study.

Guidelines for almond surgery in children necessary
The authors of the study call for guidelines for physicians to ensure a consistent approach and to bring the operations to a medical level necessary measure. The scientists also recommend decision-making aids for parents and children in order to better weigh the benefits against the risks of almond surgery. As Waldfahrer reported, he had been commissioned by the German Society for Otorhinolaryngology, Head and Neck Surgery with the development of guidelines. But that would have cost at least 80,000 euros incurred. „For the tonsillectomy just does not have a large enough lobby“, so foresters. „Internationally recognized are the 'Paradise criteria', which assess when frequent tonsillitis is an indication for surgical removal. These too are not applied uniformly in Germany“, the authors write in the study.

But whether the creation of guidelines for doctors alone is the most sensible way to bring the number of almond operations to a medically necessary level, Windfuhr doubted „mirror“: „But the sensation of pain varies from person to person. If it is demanded, five inflammations are not enough, I'm allowed to operate only after the sixth, that's cynicism for me. "Also foresters do not argue for a rigid solution: „The individual conversation is always important.“ A high level of suffering justifies an operation, according to the experts.

in the „Fact check health“ The authors give concrete recommendations for action. So should „an appropriate decision for or against tonsillectomy due to chronic inflammation“ only on the basis „comprehensive documentation of the previous course of the disease. This process can take a long time and there are always different doctors involved“. Children and parents should also be more involved in the decision. „Developing decision support can help educate parents and patients on evidence-based information, help you understand the scope for decision-making, and help identify your own preferences“, it goes on. In addition, the incentive structure for almond surgery must be reviewed and regional abnormalities discussed, „in order to better target the quality assurance measures“. (Ag)

Picture: Martin Büdenbender