Indications for tonsillectomy stratified by the level of evidence

Windfuhr, Jochen P.

doi:10.3205/cto000136

Cited by 11 publications

(2 citation statements)

References 454 publications

(960 reference statements)

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“…In Spain, a 2006 study based on 2002 data showed extreme variation in tonsillectomy rates, as large as 13-fold difference across 147 healthcare areas (HCAs), very unlikely to be explained by differences in children' needs across HCAs. 11 Since the 2006 study, no recent information on unwarranted variations in tonsillectomy rates in the Spanish National Health System has been released or published while guidelines, [12][13][14][15][16][17][18] systematic reviews, [19][20][21][22][23] randomised clinical trials [24][25][26][27][28] and a cohort study 29 on the indications for tonsillectomy and adenoidectomy multiplied. In the Spanish context, the societies of ENL and Paediatrics provided clear recommendations on the indications of tonsillectomy.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

“…Since the 2006 study, no recent information on unwarranted variations in tonsillectomy rates in the Spanish National Health System has been released or published while guidelines,12–18 systematic reviews,19–23 randomised clinical trials24–28 and a cohort study29 on the indications for tonsillectomy and adenoidectomy multiplied. In the Spanish context, the societies of ENL and Paediatrics provided clear recommendations on the indications of tonsillectomy 30.…”

Section: Introductionmentioning

confidence: 99%

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Revisiting systematic geographical variations in tonsils surgery in children in the Spanish National Health System: spatiotemporal ecological study on hospital administrative data

et al. 2022

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ObjectiveTo provide new evidence on how tonsils surgery in children has geographically varied over time in the context of the Spanish National Health System.DesignObservational ecological spatiotemporal study on geographical variations in medical practice, using linked administrative datasets, including virtually all surgeries performed from 2003 to 2015.SettingThe Spanish National Health System, a quasi-federal structure with 17 autonomous communities (ACs), and 203 healthcare areas (HCAs).ParticipantsPatients aged 19 and younger residing in the HCAs and ACs.InterventionsTonsillectomy with adenoidectomy (T&A); and tonsillectomies alone (T).Main endpoints(1) Evolution of T&A and T rates; (2) spatiotemporal variation in the risk of receiving T&A or T surgery at regional level (ACs) and HCAs; and (3) the fraction of the variation (FV) attributed to each of the components of variation—ACs, HCAs, year and interaction ACs year.ResultsT&A age-sex standardised rates increased over the period of analysis from 15.2 to 20.9 (5.7 points per 10 000 inhabitants). T alone remained relatively lower than T&A rates, evolving from 3.6 in 2003 to 3.9 in 2015 (0.3 points per 10 000 inhabitants). Most of the risk variation was captured at the HCAs level in both procedures (FV: 55.3% in T&A and 72.5% in T). The ACs level explained 27.6% of the FV in the risk in T&A versus 8% in T. The interaction ACs year was similar in both procedures (FV: 15.5% in T&A and 17.5% in T). The average trend hardly explained 1.46% and 1.83% of the variation, respectively.ConclusionOur study showed wide persistent variations with a steady increase in rates and risk of T&A and a stagnation of T alone, where most of the variation risk was explained at HCA level.

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Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Revisiting systematic geographical variations in tonsils surgery in children in the Spanish National Health System: spatiotemporal ecological study on hospital administrative data

et al. 2022

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Tonsillar Hypertrophy

2023

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Impact of the COVID-pandemic on the incidence of tonsil surgery and sore throat in Germany

Windfuhr

Günster

2022

Eur Arch Otorhinolaryngol

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Purpose To longitudinally evaluate the impact of the COVID-19-pandemic on the incidence of inpatient tonsil surgery and outpatient primary care of sore throat in Germany. Methods A retrospective interrupted time-series analysis was conducted. The national database of the Hospital Remuneration System was used to retrieve the number of operations performed between January 2019 and September 2021 including elective and non-elective cases with the exception of malign diseases. Three episodes were compared on a weekly basis: before, during, and after the first national lockdown (March 16–May 3, 2020). We also analysed the number of outpatient doctor contacts of sore throat patients in 2019 and 2020. Results Overall, 144,069 surgical cases were included in the analysis. The first lockdown resulted in an abrupt and significant decrease of all types of tonsil surgery ( p < 0.01). The incidence of tonsillectomy decreased from 556 (before) to 111 (during) and 326 (after) cases per week (relative risk 0.24; 95% CI 0.19–0.30, and 0.82; 95% CI 0.73–0.92). After the lockdown, the incidence persisted on a lower level compared to 2019. The number of doctor contacts decreased from 2,967,322 in 2019 to 1,976,617 in 2020 (− 33.4%). Conclusions The first lockdown was associated with a significant decrease of all types of tonsil surgery. A return to pre-pandemic surgical activity was not identified. The findings were accompanied by a significant decrease of outpatient doctor contacts of sore throat patients in primary care, particularly in the subgroup of children and adolescents. The impact of the second lockdown, starting in December 2020, was by far not comparable. Supplementary Information The online version contains supplementary material available at 10.1007/s00405-022-07308-8.

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Indications for tonsillectomy stratified by the level of evidence

Cited by 11 publications

References 454 publications

Revisiting systematic geographical variations in tonsils surgery in children in the Spanish National Health System: spatiotemporal ecological study on hospital administrative data

Revisiting systematic geographical variations in tonsils surgery in children in the Spanish National Health System: spatiotemporal ecological study on hospital administrative data

Tonsillar Hypertrophy

Impact of the COVID-pandemic on the incidence of tonsil surgery and sore throat in Germany

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