[Tonsil surgery in the federal states of Germany: similarities and differences. German version]

[Frequency of secondary tonsillectomy in Germany]

BACKGROUND

Tonsillar remnants are occasionally the subject of clinical negligence claims in tonsillectomy patients, but obligatory in every tonsillotomy procedure. In both cases, clinically relevant symptoms can require a secondary tonsillectomy (STE).

OBJECTIVE

The purpose of this retrospective longitudinal study was to identify the prevalence of STE in Germany between 2005 and 2018, using a report commissioned by the Federal Office for Statistics.

MATERIALS AND METHODS

STE was identified using the operation and procedure key (Operationen- und Prozedurenschlüssel, OPS) code 5‑281.4, and the prevalence stratified by year, age, and gender. Linear regression analysis was performed. In addition, the prevalence of tonsillectomy and tonsillotomy was determined by the OPS codes 5‑281.5, 5‑281.0, and 5.282.0.

RESULTS

Between 2005 and 2018, 11,018 patients underwent STE in Germany. The total number of STE per year decreased significantly from 1080 in 2005 to 483 in 2018 (p < 0.001). The number of inpatient tonsillotomy cases increased between 2007 and 2018 from 4658 to 18,369.

CONCLUSION

The annual number of STE in Germany decreased continually during the observation period. The population-based data used in the study were insufficient to determine whether STE had been performed after tonsillectomy or tonsillotomy. Further patient-level research is thus required.

[Sore throat as indication for tonsillectomy before and after implementation of the German guideline for tonsillitis : Longitudinal study covering 115.839 procedures]

BACKGROUND

Tonsillectomy is a reasonable indication in the management of sore throat not responding to antibiotic treatment. This longitudinal patient-level study was conducted to estimate the impact of the German guideline for the management of tonsillitis which was published in 2015.

METHODS

Data of inpatient and outpatient healthcare were retrieved from a database provided by one of the largest German health insurance companies (i.e., Allgemeine Ortskrankenkassen). Procedures for the management of chronic tonsillitis (code: J35.0) between 2012 and 2018 were identified by operation codes (5-281.0; 5‑282.0). Primary care data concerning sore throat were identified by ICD-10 codes (J02; J03; J35.0) including antibiotic prescribing by associated data of the anatomic-therapeutic-chemical classification.

RESULTS

A total of 109,895 cases were eligible for analysis. The annual number of procedures had decreased by 50.3% within the study period. The continuous decrease was emphasized after 2015. The strongest decrease was registered in children (<10 years; -65.7%). Every second patients had received conservative treatment at the most in only one preoperative quarter.

CONCLUSIONS

The impact of the German guideline on the management of sore throat on the annual number of tonsillectomies and common medical practice was limited. Antibiotic treatment appears not to play a major role when tonsillectomy is indicated.