Windfuhr J P, Chen Y-S
Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Kliniken Maria Hilf, Viersener Str. 450, 41063, Mönchengladbach, Deutschland.
Praxis für Hals‑, Nasen‑, Ohrenheilkunde, Bad Honnef, Deutschland.
HNO. 2020 Jun;68(6):426-432. doi: 10.1007/s00106-019-00796-x.
A second-opinion procedure was introduced for (adeno)tonsillectomy and tonsillotomy in 2018 by the Federal Joint Committee, due to the assumed high prevalence of both procedures. This study was conducted to quantify and analyze both types of tonsil surgery in Germany.
Data from the Federal Office of Statistics on the number of procedures and population size were used to calculate annual intervention rates between 2005 and 2017. Percentual changes in intervention rates compared to the previous year were calculated for Germany, for the total number of ENT specialists, for the ENT specialists of the federal states, and for four age groups (≤10; ≤20; ≤40; >40 years).
Regression analysis revealed a significant decrease in (adeno)tonsillectomy and a significant increase in tonsillotomy in each investigated year (p < 0.001; exception: 2006 for adenotonsillectomy). Surgical rates of tonsillectomy and tonsillotomy decreased significantly with age (p < 0.001). There was no clear relationship between the density of ENT specialists in the different federal states and the number of surgical procedures.
There was no clear association between the surgical prevalence and the density of ENT specialists. The significant decrease in rates of (adeno)tonsillectomy began in 2005 and the tonsillotomy rates have been increasing since 2007, albeit without a compensatory effect. Both procedures are on the list of the 50 most frequently performed operations. The decreasing total number of both surgical procedures questions the value of a second-opinion procedure as suggested by the Federal Joint Committee. Tonsil surgery is significantly associated with young age (<10 years) and discussions on surgery rates must consider the age structure of the investigated population, since this is the most important influencing factor in tonsil surgery.
由于（腺）扁桃体切除术和扁桃体切开术的假定高流行率，联邦联合委员会于2018年引入了针对这两种手术的二次诊断程序。本研究旨在对德国的这两种扁桃体手术进行量化和分析。
利用联邦统计局关于手术数量和人口规模的数据，计算2005年至2017年的年度干预率。计算德国、耳鼻喉科专科医生总数、联邦各州的耳鼻喉科专科医生以及四个年龄组（≤10岁；≤20岁；≤40岁；>40岁）与上一年相比干预率的百分比变化。
回归分析显示，在每个调查年份，（腺）扁桃体切除术显著减少，扁桃体切开术显著增加（p<0.001；例外情况：2006年腺扁桃体切除术）。扁桃体切除术和扁桃体切开术的手术率随年龄显著降低（p<0.001）。不同联邦州耳鼻喉科专科医生的密度与手术数量之间没有明确的关系。
手术流行率与耳鼻喉科专科医生的密度之间没有明确的关联。（腺）扁桃体切除术的比率自2005年开始显著下降，扁桃体切开术的比率自2007年以来一直在上升，尽管没有补偿效应。这两种手术都在最常进行的50种手术清单上。这两种手术的总数下降，对联邦联合委员会建议的二次诊断程序的价值提出了质疑。扁桃体手术与年轻年龄（<10岁）显著相关，关于手术率的讨论必须考虑被调查人群的年龄结构，因为这是扁桃体手术中最重要的影响因素。
