Gudnadottir Gunnhildur, Tennvall G Ragnarson, Stalfors J, Hellgren J
Department of Otorhinolaryngology, Sahlgrenska University Hospital, Sahlgrenska Academy, Gothenburg University, Gröna stråket 9, 413 46, Gothenburg, Sweden.
The Swedish Institute for Health Economics (IHE), Lund, Sweden.
Eur Arch Otorhinolaryngol. 2017 Jun;274(6):2629-2636. doi: 10.1007/s00405-017-4526-7. Epub 2017 Mar 14.
Tonsillotomy has gradually replaced tonsillectomy as the surgical method of choice in children with upper airway obstruction during sleep, because of less postoperative pain and a shorter recovery time. The aim of this study was to examine the costs related to caregivers' absenteeism from work after tonsillectomy (TE) and tonsillotomy (TT). All tonsillectomies and tonsillotomies in Sweden due to upper airway obstruction during 1 year, reported to the National Tonsil Surgery Register in children aged 1-11 were included, n = 4534. The number of days the child needed analgesics after surgery was used as a proxy to estimate the number of work days lost for the caregiver. Data from the Social Insurance Agency (Försäkringskassan) regarding the days the parents received temporary parental benefits in the month following surgery were also analysed. The indirect costs due to the caregivers' absenteeism after tonsillectomy vs tonsillotomy were calculated, using the human capital method. The patient-reported use of postoperative analgesic use was 77% (n = 3510). Data from the Social Insurance Agency were gathered for all 4534 children. The mean duration of analgesic treatment was 4.6 days (indirect cost of EUR 747). The mean number of days with parental benefits was 2.9 (EUR 667). The indirect cost of tonsillectomy was 61% higher than that of tonsillotomy (EUR 1010 vs EUR 629). The results show that the choice of surgical method affects the indirect costs, favouring the use of tonsillotomy over tonsillectomy for the treatment of children with SDB, due to less postoperative pain.
由于术后疼痛较轻且恢复时间较短，扁桃体切开术已逐渐取代扁桃体切除术，成为治疗睡眠期间上呼吸道阻塞儿童的首选手术方法。本研究的目的是探讨扁桃体切除术后（TE）和扁桃体切开术后（TT）护理人员缺勤所产生的费用。纳入了瑞典1年内因上呼吸道阻塞而进行的所有扁桃体切除术和扁桃体切开术，这些手术均上报至国家扁桃体手术登记处，涉及1 - 11岁儿童，共4534例。将儿童术后需要镇痛药的天数作为估计护理人员误工天数的指标。还分析了社会保险机构（Försäkringskassan）提供的关于父母在术后当月领取临时育儿津贴天数的数据。采用人力资本法计算扁桃体切除术后与扁桃体切开术后护理人员缺勤造成的间接费用。患者报告的术后使用镇痛药的比例为77%（n = 3510）。收集了所有4534名儿童的社会保险机构数据。镇痛治疗的平均持续时间为4.6天（间接费用为747欧元）。领取育儿津贴的平均天数为2.9天（667欧元）。扁桃体切除术的间接费用比扁桃体切开术高61%（1010欧元对629欧元）。结果表明，手术方法的选择会影响间接费用，由于术后疼痛较轻，在治疗阻塞性睡眠呼吸暂停低通气综合征儿童时，扁桃体切开术比扁桃体切除术更具优势。
