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. 2016 Dec 15:15:Doc08.
doi: 10.3205/cto000135. eCollection 2016.

Specified data for tonsil surgery in Germany

Jochen P Windfuhr  1
Affiliations

Specified data for tonsil surgery in Germany

Jochen P Windfuhr. GMS Curr Top Otorhinolaryngol Head Neck Surg. .

Abstract

Background: Tonsillectomy rates vary considerably among different states, regions, and times. This study was conducted to identify the prevalence of "chronic" tonsillitis, peritonsillar abscess, hypertrophy of the tonsils with and without adenoids in absolute and relative numbers in an 80 million people nation. Moreover, the number and rates of different surgical procedures to resolve either "chronic" tonsillitis, peritonsillar abscess, or upper airway obstruction due to (adeno)tonsillar hypertrophy over several years was evaluated in this study (tonsillectomy, adenotonsillectomy, tonsillotomy, abscess tonsillectomy, transoral incision and drainage). Finally, the post-tonsillectomy hemorrhage rate was calculated and analyzed in relation to age and gender. Material and methods: Calculations were based on data as published by the Federal Institute of Statistics or on request, if needed. The latest data were provided for 2013. Results: The total number of the aforementioned diseases (stratified by ICD-10) decreased from 142,574 (in 2000) to 87,624 in 2013 (38.5%). Tonsillectomy, with or without adenoidectomy, was performed in a total of 833,896 patients between 2006 and 2013 in Germany. The yearly number decreased continually from 120,993 in 2006 to 84,332 procedures in 2013 (30.3%). The most significant decrease was registered in patients younger than 20 years of age for this time period: 70.92 per 10,000 in 2010 to 58.68 per 10,000 in 2013. If all age groups were included, the rate decreased from 13.34 per 10,000 to 10.90 per 10,000. In contrast, an increasing number of tonsillotomies was observed between 2007 (4,659 procedures) and 2013 (11,493). The cumulated number of procedures was 59,049. A constant number of 15,000 cases with peritonsillar abscess were diagnosed per year in Germany (19 patients per 100,000). The prevalence increased significantly at an age of 15 years and there was a preponderance of female patients below that age. Compared to the transoral incision and drainage, a 2.8-fold greater number of abscess tonsillectomies were performed annually. Post-tonsillectomy hemorrhage was experienced in 5.98% of all patients after 245,721 procedures in 2010 and 2013 (all indications, except tonsillotomy). Bleeding complications had occurred less frequently in female patients (5.06% vs. 7.02%). Finally, a considerable increase of post-tonsillectomy hemorrhage in patients older than 10 years of age was registered in male patients only. Conclusion: Chronic tonsillitis was less frequently diagnosed and surgically treated in terms of tonsillectomy (with or without adenoidectomy), particularly in female patients. In contrast, the number of tonsillotomies increased continually, particularly in male patients. Peritonsillar abscess was diagnosed and surgically treated in a constant number of patients in the yearly comparison. Most of these patients were scheduled for abscess tonsillectomy, and only a 2.8-fold smaller number for transoral incision and drainage. Independent from the indication for surgery, post-tonsillectomy hemorrhage was clearly associated with male gender and age (>10 years). The study reveals a dramatic change mandating further surveillance in insurance companies and authorities in the national health system of an 80 million people nation. (Tab. 1).

Keywords: abscess tonsillectomy; bleeding complications; incisional drainage; peritonsillar abscess; post-tonsillectomy hemorrhage; surgical prevalence; tonsillectomy; tonsillotomy.

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Figures

Table 1
Table 1. Population and age structure in Germany [23]
Table 2
Table 2. Tonsillectomy without adenoidectomy (OPS code: 5-281.0). Number of procedures per year (2005–2013)
Table 3
Table 3. Prevalence of tonsillectomy in patients <20 years (2010 vs. 2013)
The procedures were predominantly performed in female patients. The number of interventions had decreased by 19.6% within 3 years. (ATE = adenotonsillectomy; TE = tonsillectomy; Re-TE = revision tonsillectomy)
Table 4
Table 4. Rate of tonsillectomy in patients younger than 20 years
Based on the data of Table 3, the rates of tonsillectomy for patients younger than 20 years could be calculated for 2010 and 2013 with relation to the population statistics. Within 3 years, the rate had decreased by 17.3%.
Table 5
Table 5. Adenotonsillectomy (OPS code: 5-282)
Between 2006 and 2013, a total of 283,787 interventions were performed, revealing a decreasing yearly prevalence.
Table 6
Table 6. Peritonsillar abscess (ICD-10: J36). Prevalence, rates, and burden of health. PTA = peritonsillar abscess
Table 7
Table 7. Absences from work due to peritonsillar abscess, analysis per year. The table shows a decreasing tendency of the prevalence, the number of days of absences and number of days of absences per case between 2002 and 2008.
Table 8
Table 8. Tonsillectomy in OECD member countries
Table 9
Table 9. Population structure in Germany (in thousands)
Figure 1
Figure 1. Diagnosis of “Chronic diseases of the palatal and pharyngeal tonsil” (ICD-10: J35)
Diagram of the age groups in 5-year intervals with y-axis indicating the prevalence and x-axis the age group per year. On annual comparison, a decrease of the frequency of diagnosis in younger patients (<20 years) can be observed.
Figure 2
Figure 2. Diagnosis of “Chronic diseases of the palatal and pharyngeal tonsil” (ICD-10: J35)
The y-axis indicates the prevalence on an annual basis for male and female patients (x-axis). A decreasing prevalence of the diagnosis is revealed for the time between 2000 and 2013 without gender preference (factor 2.16).
Figure 3
Figure 3. Diagnosis of “chronic tonsillitis” (ICD-10: J35.0). The graphs indicate the prevalence (y-axis) on a yearly basis for male and female patients (x-axis). Between 2000 and 2013, the number of these diagnoses decreased by factor 1.68. This decrease was registered more often in male patients (44.4%) than in female patients (37.7%).
Figure 4
Figure 4. Diagnosis of “Hypertrophy of the palatal tonsils” (ICD-10: J35.1)
The graphs indicated the annual prevalence (y-axis) for male and female patients (x-axis). Between 2000 and 2013, the number of cases had decreased by factor 1.37. Female and male patients were equally affected.
Figure 5
Figure 5. Diagnosis of “Hypertrophy of the palatal tonsils with hypertrophy of the pharyngeal tonsil” (ICD-10: J35.3)
The graphs indicate the annual prevalence (y-axis) for male and female patients (x-axis). Between 2000 and 2013, the diagnostic frequency decreased by factor 1.53. The numbers for male and female patients were nearly identical.
Figure 6
Figure 6. Tonsillectomy. Prevalence in Germany (OPS code 5-281)
The Federal Statistical Office lists every year the 50 most frequent inpatient interventions in Germany since 2005. Among this group, TE without AT is regularly listed. Between 2005 and 2013, the total number of TE (without AT) decreased by 10,425 interventions (11%) and the surgery ranked 48 among the 50 most frequent interventions (rank 37 in 2005). The diagram shows the number of cases on the left y axis. On the right side the rank among the 50 most frequently performed procedures is depicted as indicated between 2005 and 2013 (x-axis). m = male; w = female
Figure 7
Figure 7. Tonsillectomy (OPS: 5-281), stratified based on the patients’ ages between 2006 and 2013
The graphs indicate the prevalence (y-axis) between 2006 and 2013 (x-axis), stratified by age groups (x-axis). A significant decrease was registered in younger patients (<20 years).
Figure 8
Figure 8. Tonsillectomy (OPS: 5-281), prevalence in male patients (2005-2013)
The graphs indicate the prevalence in male patients (left y- axis) and the ranking within the 50 most common inpatient procedures (right y-axis) from 2005 through 2013 (x-axis). There was only a slight decrease of the prevalence in Germany. m = male
Figure 9
Figure 9. Tonsillectomy (OPS code: 5-281), prevalence in female patients (2005–2013)
The graphs indicate the prevalence in male patients (left y-axis) and the ranking within the 50 most common inpatient procedures (right y-axis) from 2005 through 2013 (x-axis). The decrease of the prevalence was remarkable. In 2013, TE is no longer listed among the 50 most common inpatient procedures. The prevalence is higher compared to to male patients. w = female
Figure 10
Figure 10. Tonsillectomy (OPS code: 5-281.0), prevalence in 2010, stratified by age and gender
The graphs of male and female patients indicate the prevalence (y-axis) according to age groups (x-axis). There was a significant difference between male and female patients at the age of 15 to 30 years. m = male; w = female
Figure 11
Figure 11. Tonsillectomy (OPS code: 5-281.0), prevalence in 2013, stratified by age and gender
The graphs of male and female patients indicate the prevalence (y-axis) according age groups (x-axis). Comparable to 2010, a significant difference between male and female patients was found in the age 15 and 30 years. m = male; w = female
Figure 12
Figure 12. Adenotonsillectomy (OPS code: 5-282), prevalence between 2006 and 2013
The graphs indicate the prevalence (y-axis) between 2006 and 2013 (x-axis), stratified by age groups (x-axis). A significant decrease was registered in younger patients (<15 years).
Figure 13
Figure 13. Adenotonsillectomy (OPS code: 5-282.0), frequency in 2010, detailed analysis
The graphs of male and female patients indicate the prevalence (y-axis) according age groups (x-axis). A difference was only found for very young patients (<5 years) and adolescents (15–20 years). The prevalence decreased constantly with ages without gender preference. m = male; w = female
Figure 14
Figure 14. Adenotonsillectomy (OPS code: 5-282.0), frequency in 2013, detailed analysis
The graphs of male and female patients indicate the prevalence (y-axis) according age groups (x-axis). A difference was only found for very young patients (<5 years) and adolescents (15–20 years). The prevalence decreased constantly with ages without gender preference. m = male; w = female
Figure 15
Figure 15. Tonsillotomy (OPS code: 5-281.5), prevalence. The graphs indicate the prevalence (y-axis) between 2007 and 2013 (x-axis), stratified by age groups (x-axis). Since this surgery is performed only rarelyabove the age of 15, not all age groups are depicted. The prevalence constantly increases in the group of 1 to 5 year-old patients since 2007.
Figure 16
Figure 16. Tonsillotomy (OPS code: 5-281.5), prevalence in 2010, detailed analysis
The graphs of male and female patients indicate the prevalence (y-axis) according age groups (x-axis). The intervention was almost only performed in younger patients (5 to 10 years), predominantly of male gender. m = male; w = female
Figure 17
Figure 17. Tonsillotomy (OPS code: 5-281.5), frequency in 2013, detailed analysis
The graphs of male and female patients indicate the prevalence (y-axis) according age groups (x-axis). The intervention was almost only performed in younger patients (5 to 10 years), predominantly of male gender. In comparison to 2010, 30.6% more patients had undergone TOTO. m = male; w = female
Figure 18
Figure 18. Prevalence of TOTO (OPS code: 5-281.5) vs. TE (OPS code: 5-281.0)
The graphs indicate the prevalence (y-axis) between 2007 and 2013 (x-axis), stratified the type of intervention (TOTO vs. TE). The prevalence of TE decreased by 21%, but the prevalence of TOTO multiplied only by 2.5. However, the total number of interventions is decreasing with time.
Figure 19
Figure 19. Prevalence of incisional drainage (OPS code: 5-280.0) vs. abscesstonsillectomy (OPS code: 5-281.1), 2005–2013
The columns depict the percentage (y-axis) of both interventions for each year (x-axis). Between 2005 and 2013, 2,955 incisional drainages and 10,026 abscess TEs on average were performed per year. The comparison of the data over 9 years reveals an increasing prevalence of transoral incisional drainage vs. abscess TE.
Figure 20
Figure 20. Abscess tonsillectomy (OPS code: 5-281.1); stratified based on the patients’ ages (2005–2013)
The graphs indicate the prevalence (y-axis) between 2005 and 2013 (x-axis), stratified by age groups (x-axis). It can be noticed that most interventions were performed in adolescents and young adults (15 to 25 years of age) and a decreasing number of cases within the evaluation period in this age group. The prevalence increases abruptly after the age of 15 and is continually decreasing after the age of 25. The prevalence differs significantly to the prevalence of the diagnosis “chronic diseases of the palatal and pharyngeal tonsil”.
Figure 21
Figure 21. Abscess tonsillectomy (OPS code: 5-281.1), prevalence in 2010, detailed analysis
The graphs of male and female patients indicate the prevalence (y-axis) according age groups (x-axis). Before the age of 20, mostly female patients were affected, afterwards mostly male patients. m = male; w = female
Figure 22
Figure 22. Abscess tonsillectomy (OPS code: 5-281.1), prevalence in 2013, detailed analysis
The graphs of male and female patients indicate the prevalence (y-axis) according to age groups (x-axis). Before the age of 20, mostly female patients underwent surgery, afterwards male patients. m = male; w = female
Figure 23
Figure 23. Prevalence of transoral incisional drainage (OPS code: 5-280.0) in 2010, detailed analysis
The graphs of male and female patients indicate the prevalence (y-axis) according to age groups (x-axis). With the exception of younger patients (10–14 years of age) predominantly patients of male gender had undergone surgery. m = male; w = female
Figure 24
Figure 24. Prevalence of transoral incisional drainage (OPS code: 5-280.0) in 2013, detailed analysis
The graphs of male and female patients indicate the prevalence (y-axis) according to age groups (x-axis). With the exception of younger patients (10–14 years of age) predominantly patients of male gender had undergone surgery. m = male; w = female
Figure 25
Figure 25. Prevalence of transoral incisional drainage (OPS code: 5-280.0) vs. abscesstonsillectomy (OPS code: 5-281.1) in male patients in 2010
The graphs indicate the prevalence (y-axis) of both interventions stratified by age groups (x-axis). Abscesstonsillectomy prevailed and incisional drainage was performed to a significant extent only after the age of 15 years. m = male; w = female
Figure 26
Figure 26. Frequency of transoral incisional drainage (OPS code: 5-280.0) vs. abscesstonsillectomy (OPS code: 5-281.1) in male patients in 2013
The graphs indicate the prevalence (y-axis) of both interventions stratified by age groups (x-axis). Abscesstonsillectomy prevailed and incisional drainage was performed to a significant extent only after the age of 15 years. m = male
Figure 27
Figure 27. Frequency of transoral incisional drainage (OPS code: 5-280.0) vs. abscesstonsillectomy (OPS code: 5-281.1) in female patients in 2010
The graphs indicate the prevalence (y-axis) of both interventions stratified by age groups (x-axis). Abscesstonsillectomy prevailed and incisional drainage was performed to a significant extent only after the age of 15 years. w = female
Figure 28
Figure 28. Frequency of transoral incisional drainage (OPS code: 5-280.0) vs. abscesstonsillectomy (OPS code: 5-281.1) in female patients in 2013
The graphs indicate the prevalence (y-axis) of both interventions stratified by age groups (x-axis). Abscesstonsillectomy prevailed and incisional drainage was performed to a significant extent only after the age of 15 years. w = female
Figure 29
Figure 29. Rate of post-tonsillectomy hemorrhage in 2010
After 60,794 interventions in male patients (coded as explained in chapter 3.6.1), a postoperative bleeding rate of 7.04% was calculated vs. 5.02% after 70,292 interventions in female patients. The bleeding rate correlates with the age up to 15 years in boys and girls. Afterwards, the age-related hemorrhage rate increases only in male patients until the age of 30 years, and decreases later. In female patients, the postoperative bleeding rate was nearly unchanged after the age of 15 years. m = male; w = female
Figure 30
Figure 30. Rate of post-tonsillectomy hemorrhage in 2013
After 54,259 interventions in male patients (coded as explained in chapter 3.6.1), a postoperative bleeding rate of 6.99% was calculated vs. 5.11% after 60,376 interventions in female patients. The phenomena observed for 2010 can be reproduced in a nearly identical way. The bleeding rate correlates with the age up to 15 years in boys and girls. Afterwards, the age-related hemorrhage rate increases only in male patients until the age of 30 years, and decreases later. In female patients, the postoperative bleeding rate was nearly unchanged after the age of 15 years. m=male; w=female
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