A 4-year retrospective study of tonsillectomy rate and admission rate of tonsillitis and complications in the East of England and nationally

OBJECTIVES

Guidance set out by Scottish Intercollegiate Guidelines Network (SIGN) sought to restrict the frequency of elective tonsillectomy in reaction to the recognised and substantial risks of the procedure, namely pain and bleeding. With stricter criteria in place before a patient can undergo tonsillectomy, patients must endure more episodes of tonsillitis than was previously the case. The cost of managing tonsillitis and its complications as an inpatient is substantial to the NHS and also to the economy as a whole in missed work days. The authors sought to establish if the reduced rate of tonsillectomy performed had any effect on the rate of acute hospital admission for tonsillitis or the associated abscesses-peritonsillar, parapharyngeal and retropharyngeal.

METHODS

A retrospective multi-centre study reviewed admission data across a 4-year period. The rate of tonsillectomies performed for recurrent tonsillitis across four trusts in Mid-Essex was compared with the number of admissions for tonsillitis, peritonsillar, parapharyngeal and retropharyngeal abscesses. National hospital episode statistics data over a 5-year period was also analysed.

RESULTS

For the regional data in 2015, 979 tonsillectomies were performed across the four centres, reducing to 875 in 2018. There was no trend in the rates of acute tonsillitis requiring admission but the rates of peritonsillar abscess increased from 156 to 192 cases per year in the same period. This correlation was found not to be statistically significant in the measured sample size. The National hospital episode statistics data showed a significant correlation between tonsillectomy rates and admissions from complications of tonsillitis as well as the associated abscesses.

CONCLUSION

This study shows that the reduced tonsillectomy rate was correlated with an increased number of admissions with peritonsillar abscess regionally. Nationally reduced tonsillectomy rate is significantly associated with increased admissions with tonsillitis and all its complications. A decreased rate of tonsillectomy may be increasing the rate of serious tonsillitis. This has an impact on patient morbidity, an increasing financial burden on the NHS and the UK economy.

Is the rotarod test an objective alternative to the gait score for evaluating walking ability in chickens?

Walking ability is related to motor co-ordination which, in rodents, can be assessed by an established test in pharmacological studies — the rotarod test. The purpose of this study was to evaluate a modified rotarod test for chickens and its relation to the often-used gait score system. At the end of their rearing period, we tested 138 male chickens (Gallus gallus domesticus) from three differing growth performance strains: Ross 308 (fast-growing; n = 46), Lohmann Dual (medium-growing; n = 46) and Lohmann Brown Plus (slow-growing; n = 46). First, the chickens gait scores were assessed and, immediately following this, they were placed gently onto a steady rod. The velocity of the rotating rod gradually increased, and the latency to leave the rod was recorded. By using a linear mixed model, we were able to show that the latency to leave the rotating rod was significantly predicted by the gait score. Fast-growing chickens had shorter durations on the rotating rod, and these durations were associated with gait score. We conclude that the rotarod test provides an objective alternative method for assessing walking ability in chickens without the need for intense observer training or the risk of observer biases and propose that this novel methodology has the potential to function as a precise, objective indicator of animal welfare.

Energy expenditure of autoperfusing heart-lung preparation

The autoperfused heart-lung preparation was developed as a method for extending the acceptable donor-to-recipient interval in clinical heart-lung transplantation. Metabolic substrate enhancement has been shown to be necessary for the survival and homeostasis of the functioning preparation. To define basic metabolic requirements and to determine the resting energy expenditure of the working canine heart-lung preparation, two groups were studied. Ten canine heart-lung blocks were placed in a normothermic autoperfusion circuit. In Group 1 (n = 5), a hyperalimentation solution of balanced substrate was infused (15% dextrose, 4.25% amino acids, 8 meq magnesium sulfate, 30 IU/dl insulin, and 10% lipids). In Group 2 (n = 5), no substrate was given. The preparations were ventilated with a mixture of room air and 5% CO2 at a rate of 4 breaths/min to maintain physiological pH. Myocardial function was assessed by cardiac output determinations and mixed venous gases. Pulmonary function was assessed with arterial blood gases. The oxygen consumption (VO2) and carbon dioxide production (VCO2) were measured with a Metabolic Cart, and the resting energy expenditure was calculated. The mean survival time for Group 1 was 360 minutes, and all preparations were terminated electively. The mean survival time for Group 2 was 219 +/- 43 minutes (p less than 0.01) with congestive heart failure as the common terminal event. All parameters of cardiac function and blood gases remained within physiological limits without significant differences between groups. The resting energy expenditure, a measure of metabolic rate, was 2.5 +/- 0.3 kcal/hr in Group 1 and 1.0 +/- 0.2 in Group 2 at termination (mean +/- SD) (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)