Unnecessary almond and blind arm operations seem to be dependent on the treatment site

Children are operated much more frequently in some regions
In many regions of Germany children are much more often removed the tonsils or the appendix than elsewhere, which is not due solely to medical necessity, reports the AOK based on a recent evaluation of the Scientific Institute of the AOK (WIdO). "Not only origin and social situation, but also the place of residence decide on the health chances of children and adolescents", so the message of the health insurance. "The health care of our children and adolescents must not depend on the postal code," warns Martin Litsch, designated chairman of the AOK Federal Association. "All children have the right to the same, high-quality care," said Litsch at the press conference on the publication of the report.

AOK's 2015 New Care Report shows that in almond and caecum surgery there are significant regional differences in "whether and when surgery is performed." The causes of these regional differences are still unclear, but they can not "alone have medical reasons, "explains Jürgen Klauber, Managing Director of WIdO and co-editor of the care report. Here, the indication should be questioned more. The place of residence should have no influence on the quality of medical care, the experts remind. Although there is room for improvement in individual areas, overall health care in Germany is good.

Mandible operations should only be considered after unsuccessful treatment with antibiotics, but removal is often done without prior antibiotic therapy. (Image: Matthias Stolt / fotolia.com)

Almond and intestine operations evaluated
Data from AOK patients under the age of 24 years were analyzed for the care report, including either almond removal (tonsillectomy) or partial removal of the tonsils (tonsillarotomy) at the hospital. The scientists of the WIdO found that in the nationwide average the standardized operation rate in 2012 was 37 in 37 operated patients per 10,000 inhabitants. However, individual regions showed significant deviations from this mean. In the region of Magdeburg, for example, there were 66 such interventions per 10,000 inhabitants, whereas in the Ingolstadt region only 17 per 10,000 inhabitants were operated on the almonds. Ingolstadt, on the other hand, was in the upper range with 51.8 per 10,000 inhabitants in the appendectomy, while the nationwide operating rate was around 27 patients per 10,000 children and adolescents under the age of 18, according to the AOK. In the region of Schleswig-Holstein East only 13 out of 10,000 children and adolescents had been operated on the appendix.

Conservative treatment used only little
For the current report, the experts also evaluated the extent to which an operation with antibiotics in almond operations prior to the procedure took place, as recommended in the medical guidelines for certain almond diseases. "In fact, in the last year before the surgical quarter, 35 percent of tonsillectomy patients did not have a single tonsillectomy with antibiotic treatment," said the AOK. In 64 percent of those operated on, a corresponding antibiotic therapy was carried out for a maximum of two quarters of a three-year period. "Obviously, in a considerable part of the cases, the possibilities of conservative therapy were used little or not at all," criticizes Jürgen Klauber. In the current guidelines of the Society for Otorhinolaryngology and the Society for Paediatrics and Adolescent Medicine surgery (tonsillectomy or Tonsillotomien) is considered only as a therapeutic option, if in 12 to 18 months at least six times a purulent tonsillitis (Tonsillitis) was treated with antibiotics, explains the AOK.

Child health is a national cross-cutting task
The care report addresses other critical issues that affect the health of children and adolescents. First of all, however, access to medical care must be equally good for everyone, so that all children and adolescents have the same opportunities to grow up healthily. Bernt-Peter Robra, Director of the Institute for Social Medicine and Health Economics at the Otto von Guericke University Magdeburg, also co-editor of the care report. Health opportunities are above all social opportunities. The promotion of child health is a cross-national task, with more attention being paid to "the scourge of obesity, for example". Parents and families, day-care centers and schools, local authorities, politics and, of course, health care as a whole are required to participate in the prevention of obesity.

Health knowledge crucial for prevention
A key factor in prevention, according to the experts, is the health knowledge of the population. For example, knowledge about the hidden sugar in food plays an essential role in the prevention of obesity. However, "two thirds of Germans would not know how much sugar they consume daily," explains Martin Litsch, citing a population survey commissioned by the AOK. "In view of increasing numbers of obesity and diabetes, we urgently need more education and transparency," continues Litsch.

A criticism for the experts is also the inadequate study of the effect of drugs in children. Given the lack of knowledge, children would have to be treated again and again with medicines that were previously only examined and tested on adults, explains Dr. med. Karl-Josef Eßer, Secretary General of the German Society for Paediatrics and Youth Medicine (DGKJ) in the press release of the AOK. "Children also have a right to safe medicines. But at least 50 percent of medicines used in children today are not tested for their age group, "emphasizes Esser. "This shortage endangers our children," the expert continues. (Fp)