Immediate Adenoidectomy vs Initial Watchful Waiting Strategy in Children With Recurrent Upper Respiratory Tract Infections

Boonacker, Chantal Wb; Aardweg, Maaike T. A. van den; Broos, Pieter H.; Hoes, Arno W.; Schilder, Anne G. M.; Rovers, Maroeska M.

doi:10.1001/jamaoto.2013.1324

Cited by 9 publications

(8 citation statements)

References 8 publications

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“…Despite the limitations of a single center (Tuscany is recognized as a region with excellent patient care in the Italian scenario) retrospective analysis, our data evidence the difficulties in the recognition of PFAPA syndrome and in the appropriate management of PFAPA patients. Additionally, by comparing the costs of our cohort of patients with those ones derived from common diseases of childhood, emerged that PFAPA patients have a higher economic costs compared to conditions including asthma, atopic disease, recurrent respiratory infections, and celiac disease (22–25). On the contrary, the direct cost for a patient with juvenile idiopathic arthritis (JIA) is markedly higher, as expected (26–28).…”

Section: Discussionmentioning

confidence: 99%

Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Cervical Adenitis Syndrome (PFAPA): A Clinical Challenge for Primary Care Physicians and Rheumatologists

2019

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Objective: To show the different physician's approaches and the difficulties in the diagnosis and management of the Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Cervical Adenitis (PFAPA) syndrome, and to quantify the impact of the disease on the families and on the healthcare system. Study Design: Retrospective analysis on 40 patients diagnosed with PFAPA, focusing on the clinical phenotype, the process of diagnosis, and the management of the febrile episodes. The direct and indirect annual economic cost related to PFAPA in the period preceding the diagnosis were also investigated. Results: The median age of patients at disease onset was 1.75 years and the median time to diagnosis was 14.5 months. During the diagnostic process, only 45% of our patients was firstly addressed to rheumatologic consultation, 32.5% to otorinolaryngologist (ORL), and 22.5% to immunologic consultation. Genetic investigations were performed in the 20% of the cohort. Overall population experienced a median of 60 annual days of fever and, during the critical phase, 40% of patients received more than 5 cycles of antibiotic/year. Seventy five percent required laboratory investigations, 18 (45%) needed to access to emergency department and 15 (37.5%) have been hospitalized. The annual mean direct cost was 1659.5 € for each patient, and the estimated mean indirect cost was 5811.6 € for each parent. Conclusion: Despite a benign clinical course, PFAPA syndrome is associated with a significant impact on the patients, their families and the national healthcare system. PFAPA patients require a large number of medical examinations and laboratory or instrumental investigations during the diagnostic approach and often receive inappropriate treatments. Therefore, we suggest the necessity of a greater awareness and knowledge of the disease among primary care physicians and, finally, of the adoption of more specific diagnostic criteria.

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Section: Discussionmentioning

confidence: 99%

Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Cervical Adenitis Syndrome (PFAPA): A Clinical Challenge for Primary Care Physicians and Rheumatologists

2019

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“…day care, parental leave of absence). We adjusted for inflation using the consumer price index 3,16,17 . Compared to an initial watchful waiting policy, the differences in societal costs for adenotonsillectomy and adenoidectomy were €324 (ie €252 plus 28.5% inflation from 2002 to 2017) and € 608 (ie €541 plus 12.3% inflation from 2009 to 2017), respectively.…”

Section: Methodsmentioning

confidence: 99%

Changes in healthcare utilisation for paediatric tonsillectomy and adenoidectomy in the Netherlands: a population‐based study

Munster

Najafabadi

Hooft

et al. 2020

Clinical Otolaryngology

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Objectives Tonsillectomy and adenoidectomy in children are controversial subjects with large regional variation in surgical rates, partly explained by cultural differences and lack of high‐quality evidence on indications for surgery. A quality of care cycle was executed on this topic in the Netherlands. The objective of this study was to estimate changes in healthcare utilisation for paediatric tonsil surgery in the Netherlands. Methods Population‐based data on tonsillectomies and adenoidectomies in children up to age 10 were retrieved retrospectively from Dutch administrative databases between 2005 and 2018. A change point analysis was performed to detect the most pivotal change point in surgical rates. We performed univariate analyses to compare surgical patients’ characteristics before and after the pivotalpoint . Impact on healthcare budget and societal costs were estimated using current prices and data from cost‐effectiveness analyses. Results The annual number of adenotonsillectomies reduced by 10 952 procedures (−39%; from 129 per 10 000 children to 87 per 10 000 children) between 2005 and 2018, and the number of adenoidectomies by 14 757 procedures (−49%; from 138 per 10 000 children to 78 per 10 000 children). The most pivotal change point was observed around 2012, accompanied by small changes in patient selection for surgery before and after 2012. An estimated €5.3 million per year was saved on the healthcare budget and €10.4 million per year on societal costs. Conclusion The quality of care cycle resulted in fewer operations, with a concomitant reduction of costs. We suggest that part of these savings be invested in new research to maintain the quality of care cycle.

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“…27 In 2011, a trial on this topic reported similar outcomes, and higher healthcare and societal costs, for adenoidectomy compared to watchful waiting. 11,28,29 During an international consensus conference in 2017 on the management of otitis media with effusion (OME), it was advised that adenoidectomy only be performed in children aged over four years who suffer from OME with symptomatic adenoid hypertrophy. 30 In 1984, specific indications for tonsillectomy in children with severe tonsillitis were defined, known as the Paradise criteria, and international consensus was reached on this topic.…”

Section: Changes In Indications For Tonsil Surgery In Childrenmentioning

confidence: 99%

The impact of new evidence on regional variation in paediatric tonsillectomy and adenoidectomy: a historical review

et al. 2020

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BackgroundTonsillectomy and adenoidectomy have been among the most commonly performed procedures in children for approximately 100 years. These procedures were the first for which unwarranted regional variation was discovered, in 1938. Indications for these procedures have become stricter over time, which might have reduced regional practice variation.MethodsThis paper presents a historical review on practice variation in paediatric tonsillectomy and adenoidectomy rates. Data on publication year, region, level of variation, methodology and outcomes were collected.ResultsTwenty-one articles on practice variation in paediatric tonsil surgery were included, with data from 12 different countries. Significant variation was found throughout the years, although a greater than 10-fold variation was observed only in the earliest publications.ConclusionNo evidence has yet been found that better indications for tonsillectomy and adenoidectomy have reduced practice variation. International efforts are needed to reconsider why we are still unable to tackle this variation.

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Immediate Adenoidectomy vs Initial Watchful Waiting Strategy in Children With Recurrent Upper Respiratory Tract Infections

Abstract: trialregister.nl Identifier:NTR968; isrctn.org Identifier:ISRCTN03720485.

Cited by 9 publications

References 8 publications

Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Cervical Adenitis Syndrome (PFAPA): A Clinical Challenge for Primary Care Physicians and Rheumatologists

Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Cervical Adenitis Syndrome (PFAPA): A Clinical Challenge for Primary Care Physicians and Rheumatologists

Changes in healthcare utilisation for paediatric tonsillectomy and adenoidectomy in the Netherlands: a population‐based study

The impact of new evidence on regional variation in paediatric tonsillectomy and adenoidectomy: a historical review

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