Big differences in almond surgeries in children

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Large regional differences in the frequency of tonsil surgery in children

Almond surgeries in children are among the most common inpatient general anesthetic procedures. In 2010 the tonsils were removed from around 69,000 children and adolescents up to 19 years of age. In a regional comparison commissioned by Bertelsmann, the "Health Facts Check", there are clear differences. The reason could be the lack of a basis for decision-making for doctors. While 27 tonsils were removed from 10,000 children in Berlin, 76 children from Bremen were removed.

Place of residence decides on almond surgeries in children
Many children often have a sore throat, snore and wheeze. The result: the almonds have to go out. However, the study "Health Fact Check" commissioned by Bertelsmann questions whether this decision is always the best. A regional comparison shows that the frequency of almond surgery depends in part strongly on the place of residence. The evaluation of hospital registers and data from the Federal Statistical Office showed that in some regions only every 900th child has the tonsils removed, while in other regions it affects every 70th child. Apparently not only medical facts count, but often also local views of doctors when deciding. Last but not least, presumably the supply situation and economic factors also have an impact. So far, there are no binding guidelines for tonsillectomy (removal of the tonsils) in Germany.

Almost 60 percent of tonsil surgeries in children are performed due to recurrent tonsillitis. Another third of the interventions are due to enlarged tonsils. "There is hardly an operation that depends so much on the experience of the doctor and the assessment of the complaints of his patients," said specialist for ear, nose and throat medicine, Jochen Windfuhr. He acted as advisor for the study. With recurrent tonsillitis and enlarged tonsils, the removal of the troublemaker can help for a short time, but doctors, parents and children should not neglect the risks of the procedure, but general anesthesia can also pose potential life-threatening risks. "Many patients and many doctors who do not specialize in ear, nose and throat medicine are not always aware of the consequences of the operation, "said Windfuhr, who works in the Maria Hilf clinics in Mönchengladbach.

When are almond surgeries necessary for children?
According to the Bertelsmann study, the decision to have an tonsil surgery due to chronic inflammation was made twelve times more often than in others. With enlarged tonsils, surgery was even up to 58 times more frequent in some regions. “The data show that children are likely to be operated on too often in some regions. In other regions, on the other hand, the intervention does not take place, even if it were justified, "Frank Waldfahrer, senior physician at the Otolaryngology Clinic in Erlangen, told Spiegel. One of the reasons for the serious differences is probably due to the partial The study showed that in regions without an ENT department the least amount of surgery was carried out, whereas in areas with large departments for ENT diseases, an above-average amount of surgery was performed.

In many small specialist divisions, almond surgeries make up the core business. The study found that in 2010, 175 of 673 departments had tonsillectomies in more than half of the surgeries, and in 71 they represented more than two thirds of the operations. The Health Fact Check states the economic aspects of almonds -OPs: "Overall, health insurances annually pay around 150 million euros for the inpatient removal of tonsils." By reducing the number of tonsil removals, a few million euros could be saved, but the amount would drop compared to the total expenditure of hospitals hardly any weight. “However, the economic importance of almond palate removal is high for most ENT departments. The operation is usually a well-planned service and is carried out in every fifth fully inpatient case of the ENT departments, ”says a report on the study.

Guidelines for tonsil surgery in children necessary The authors of the study call for guidelines for doctors to ensure a uniform approach and to bring the operations to a level that is necessary from a medical point of view. The scientists also recommend decision-making aids for parents and children in order to better weigh the benefits against the risks of tonsil surgery. As Waldfahrer reported, he was commissioned by the German Society for Otorhinolaryngology, Head and Neck Surgery to develop guidelines. But that would have cost at least 80,000 euros. "Tonsillectomy simply does not have a sufficiently large lobby," says Waldfahrer. “The‘ Paradise criteria ’are internationally recognized, which are used to assess when frequent tonsillitis is an indication for surgical removal. These are also not used 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 tonsil surgeries to a medically necessary level, Windfuhr questioned "Spiegel": "The sensation of pain alone varies from person to person. If it is requested that five inflammations are not enough, I am only allowed to operate after the sixth, that is cynicism for me. "Even Waldfahrer does not advocate a rigid solution:" It is always important to have an individual conversation. "A high level of suffering also justifies an operation, according to the experts.

In the "Health facts check", the authors give concrete recommendations for action. For example, "an appropriate decision for or against an tonsil operation due to chronic inflammation" should only be made on the basis of "comprehensive documentation of the previous course of the disease. This process can take a long time and different doctors are always involved ”. Children and parents should also be more involved in the decision. "The development of a decision support can help to provide parents and patients with evidence-based information, clarify the scope for decision-making and support them in identifying their own preferences," it continues. In addition, the incentive structure for almond surgeries had to be checked and regional abnormalities discussed "in order to be able to target the quality assurance measures accordingly". (ag)

Also read:
Bad breath due to inflamed tonsils

Image: Martin Büdenbender /

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