Abstract
Purpose
To evaluate trends in hospital admissions in Germany for acute infections of the upper airway and deep neck in the context of the number of tonsil-related surgical procedures between 2005 and 2017.
Methods
A retrospective longitudinal population-based cohort study was performed including all unplanned admissions for acute pharyngitis/tonsillitis, abscess formation of the peritonsillar or retropharyngeal/parapharyngeal space. Elective procedures included tonsillectomy (with or without adenoidectomy), secondary tonsillectomy, and tonsillotomy. Emergency operations encompassed abscess-tonsillectomy and transoral drainage procedures of the peritonsillar/parapharyngeal/retropharyngeal space.
Results
553.600 admissions were registered in total with a significant, stepwise increase between 2005 and 2017, including retropharyngeal/parapharyngeal abscess (47.0%), acute tonsillitis (30.8%), acute pharyngitis (26.5%) and peritonsillar abscess (7.9%). There were 1.323.984 elective operations with a significant decrease during the study period. A total of 188.316 emergency operations were done, a significant decrease in the number of abscess-tonsillectomies was compensated by the increased number of transoral peritonsillar abscess drainages. The number of transoral parapharyngeal and retropharygeal abscess drainage procedures did not change significantly (p = 0.846; p = 0.846). Negative correlation was significant between admissions for chronic tonsillitis and emergency admissions (Pearson correlation coefficient = − 0.879, p < 0.001) and also between elective and emergency operations (r = − 0.667; p = 0.013).
Conclusions
Concerning infections of the upper airway and deep neck spaces, German Hospitals have to prepare strategies for the increasing challenge by unplanned admissions and emergency operations. Further research is required to clarify whether this phenomenon is caused by the significant decrease in the number of elective operations.
Similar content being viewed by others
References
Stuck BA, Götte K, Windfuhr JP et al (2008) Die Tonsillektomie im Kindesalter. Dtsch Arztebl 105:852–861
Šumilo D, Nichols L, Ryan R et al (2019) Incidence of indications for tonsillectomy and frequency of evidence-based surgery: a 12-year retrospective cohort study of primary care electronic records. Br J Gen Pract 69:e33–e41
Eurostat Statistics Explained (2018) Surgical operations and procedures statistics. Selected large decline procedures performed in hospitals, 2010, 2011, 2015 and 2016 https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Surgical_operations_and_procedures_statistics#Number_of_surgical_operations_and_procedures. Accessed Nov 2018
https://Stats.Oecd.Org/Index.Aspx?Queryid=30167#. Accessed Nov 2018
Banigo A, Moinie A, Bleach N et al (2018) Have reducing tonsillectomy rates in England led to increasing incidence of invasive Group A Streptococcus infections in children? Clin Otolaryngol 43:912–919
Mcleod R, Brahmabhatt P, Owens D (2017) Tonsillectomy is not a procedure of limited value—the unseen costs of tonsillitis and quinsy on hospital bed consumption. Clin Otolaryngol 42:573–577
Windfuhr JP (2016) Specified data for tonsil surgery in Germany. GMS Curr Top Otorhinolaryngol Head Neck Surg 15:Doc08
Bevölkerung zum Stichtag 31.12. des jeweiligen Jahres. Gliederungsmerkmale: Jahre, Region, Alter, Geschlecht, Nationalität (Grundlage Zensus 2011). https://www.gbe-bund.de. Accessed 30 Nov 2018
Bevölkerung zum Stichtag 31.12. des jeweiligen Jahres. Gliederungsmerkmale: Jahre, Region, Alter, Geschlecht, Nationalität (Grundlage Zensus BRD 1987, DDR 1990). https://www.gbe-bund.de. Accessed30 Nov 2018
Bei den Ärztekammern registrierte Ärztinnen und Ärzte mit Gebiets- und Facharztbezeichnung (absolut, je 100.000 Einwohner und Einwohner je Arzt). Gliederungsmerkmale: Jahre, Region, Alter, Geschlecht, Gebiets-/Facharztbezeichnung, Tätigkeitsbereich. https://www.gbe-bund.de. Accessed Nov 2018
Koshy E, Murray J, Bottle A et al (2012) Significantly increasing hospital admissions for acute throat infections among children in England: is this related to tonsillectomy rates? Arch Dis Child 97:1064–1068
Al-Hussaini A, Owens D, Tomkinson A (2013) Health costs and consequences: have UK national guidelines had any effect on tonsillectomy rates and hospital admissions for tonsillitis? Eur Arch Otorhinolaryngol 270:1959–1965
Yap D, Harris A, Clarke J (2017) Serious tonsil infections versus tonsillectomy rates in Wales: A 15-year analysis. Ann R Coll Surg Engl 99:31–36
Lau A, Upile N, Wilkie M et al (2014) The rising rate of admissions for tonsillitis and neck space abscesses in England, 1991–2011. Ann R Coll Surg Engl 96:307–310
Management of sore throat and indications for tonsillectomy (2010) https://www.sign.ac.uk/sign-117-management-of-sore-throat-and-indications-for-tonsillectomy.html. https://www.SIGN.ac.uk/pdf/Sign117.Pdf. Accessed 4 Apr 2019
Douglas C, Altmyer U, Cottom L et al (2019) A 20-year observational cohort of a 5 million patient population-Tonsillectomy rates in the context of two national policy changes. Clin Otolaryngol 44:7–13
Mcsweeney LA, Rousseau NS, Wilson JA et al (2017) Stakeholders' views of recurrent sore throat, tonsillitis and their management: a qualitative interview study for the NAtional Trial of Tonsillectomy IN Adults (NATTINA Part 1). Clin Otolaryngol 42:301–306
https://www.rki.de. Accessed 05 May 2019
Klug TE (2017) Peritonsillar abscess: clinical aspects of microbiology, risk factors, and the association with parapharyngeal abscess. Dan Med J 64:1–39
Windfuhr JP, Toepfner N, Steffen G et al (2016) Clinical practice guideline: tonsillitis I. Diagnostics and nonsurgical management. Eur Arch Otorhinolaryngol 273:973–987
https://www.NICE.org.uk/Guidance/Ng84. Accessed 05 May 2019
WHO (2019) Global priority list of antibiotic-resistant bacteria to guide research, discovery, and development of new antibiotics. https://www.who.int/medicines/publications/global-priority-list-antibiotic-resistant-bacteria/en/. Accessed 05 May 2019
https://www.degam.de/Patienteninformationen.Html. 04 Jan 2019
Windfuhr JP, Toepfner N, Steffen G et al (2016) Clinical practice guideline: tonsillitis II. Surgical management. Eur Arch Otorhinolaryngol 273:989–1009
Baier N, Geissler A, Bech M et al (2019) Emergency and urgent care systems in Australia, Denmark, England, France, Germany and the Netherlands—analyzing organization, payment and reforms. Health Policy 123:1–10
Crowson M, Ryan M, Rocke D et al (2017) Variation in tonsillectomy rates by health care system. Int J Pediatr Otorhinolaryngol 94:40–44
Landis BN (2013) Tonsillectomy: a simple surgical procedure? ORL J Otorhinolaryngol Relat Spec 75:121–122
Scherer M, Luhmann D, Kazek A et al (2017) Patients attending emergency departments. Dtsch Arztebl Int 114:645–652
Die 20 häufigsten Operationen bei Kindern. https://www.destatis.de. Accessed 04 Jan 2019.
Payne GC, Payne RE, Farewell DM (2008) Rugby (the religion of Wales) and its influence on the Catholic church: should Pope Benedict XVI be worried? BMJ 337:a2768
Windfuhr JP, Zurawski A (2016) Peritonsillar abscess: remember to always think twice. Eur Arch Otorhinolaryngol 273:1269–1281
Al-Mahtot M, Barwise-Munro R, Wilson P et al (2018) Changing characteristics of hospital admissions but not the children admitted—a whole population study between 2000 and 2013. Eur J Pediatr 177:381–388
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Research involving human and animals
This article does not contain any studies with human participants or animals performed by any of the authors.
Ethical approval
According to the policy of the IRB responsible for the authors, this study was exempt from ethical approval because it was a secondary analysis of a publicly available dataset with anonymous data.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations
Rights and permissions
About this article
Cite this article
Windfuhr, J.P., Chen, YS. Hospital admissions for acute throat and deep neck infections versus tonsillectomy rates in Germany. Eur Arch Otorhinolaryngol 276, 2519–2530 (2019). https://doi.org/10.1007/s00405-019-05509-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-019-05509-2