Unnecessary tonsil and appendectomy operations apparently depend on the place of treatment

Unnecessary tonsil and appendectomy operations apparently depend on the place of treatment

Children are operated on significantly more often in some regions
In some regions of Germany, tonsils or appendix are removed from children much more often than elsewhere, which is not solely due to medical necessity, reports the AOK based on a current evaluation by the AOK Scientific Institute (WIdO). "Not only origin and social situation, but also the place of residence determine the health opportunities of children and adolescents", the health insurance company said. "The health care of our children and adolescents must not depend on the postcode," warns Martin Litsch, designated board member of the AOK federal association. "All children have the right to the same, high-quality care", Litsch emphasized at the press conference on the publication of the report.

The AOK Scientific Institute's new 2015 report shows that there are significant regional differences in almond and appendix operations, "whether and when surgery is being carried out." The causes of these regional differences have so far been unclear, but they cannot "alone." have medical reasons, ”explains Jürgen Klauber, Managing Director of WIdO and co-editor of the supply report. Here, the indication must be questioned more. The place of residence should not have any influence on the quality of medical care, the experts warn. Even if there is room for improvement in individual areas, overall health care in Germany is good.

Almond and bowel operations evaluated
For the care report, data from AOK patients under the age of 24 were evaluated, for example, in which either tonsil removal (tonsillectomy) or partial tonsil removal (tonsillotomy) was performed in the hospital. The scientists at WIdO found that the nationwide average rate of surgery in 2012 was 37 patients operated on per 10,000 inhabitants. However, individual regions showed clear deviations from this mean. In the Magdeburg region, for example, 66 such interventions were performed per 10,000 inhabitants, while in the Ingolstadt region only 17 per 10,000 inhabitants were operated on the tonsils. In contrast, Ingolstadt had 51.8 per 10,000 inhabitants in the upper area, while the nationwide operation rate was around 27 patients per 10,000 children and adolescents under the age of 18, according to the AOK. In the Schleswig-Holstein Ost region, only 13 out of 10,000 children and adolescents were operated on in the appendix.

Conservative treatment little used
For the current report, the experts also evaluated the extent to which antibiotic therapy had taken place in the run-up to the procedure, as recommended in the medical guidelines for certain tonsil diseases. "In fact, 35 percent of tonsillectomy patients did not have a single tonsillitis with antibiotic treatment last year before the operation quarter," said the AOK. In 64 percent of those operated on, antibiotic therapy was given in a maximum of two quarters of a three-year period. "Obviously, in a considerable part of the cases, the possibilities of conservative therapy were used little or not at all," criticizes Jürgen Klauber. In the current guidelines of the Society for Otorhinolaryngology and the Society for Pediatric and Adolescent Medicine, surgery (tonsillectomies or tonsillotomies) is only considered as a therapeutic option if purulent tonsillitis occurs at least six times in 12 to 18 months (Tonsillitis) was treated with antibiotics, explains the AOK.

Child health a national cross-cutting task
The care report also addresses other critical aspects that have an impact on the health of children and adolescents. First of all, however, access to medical care must be equally good for everyone in order to give all children and adolescents the same opportunities to grow up healthy, emphasizes Professor Dr. Bernt-Peter Robra, director of the Institute for Social Medicine and Health Economics at the Otto von Guericke University Magdeburg, also co-editor of the health care report. Health opportunities are above all social opportunities. The promotion of child health is a national cross-sectional task, whereby "for example the scourge overweight" must be given more attention. Here parents and families, daycare centers and schools, municipalities, politics and of course the health system as a whole are required to participate in the prevention of obesity.

Health knowledge is crucial for prevention
According to the experts, an essential factor in prevention is health knowledge among the population. For example, knowledge about the hidden sugar in food plays an essential role in preventing overweight. However, "two thirds of Germans do not know how much sugar they consume every day," explains Martin Litsch, referring to a population survey on behalf of the AOK. "In view of the increasing numbers of obesity and diabetes, we urgently need more information and transparency," continues Litsch.

Another point of criticism for the experts is the inadequate investigation of the effects of medicinal products on children. Given the lack of knowledge, children would have to be treated with medication that had previously only been examined and checked on adults, explains Dr. Karl-Josef Eßer, General Secretary of the German Society for Pediatric and Adolescent Medicine (DGKJ) in the AOK press release. “Children also have the right to safe medicines. But at least 50 percent of the medicines used in children today have not been tested for their age group, ”emphasizes Eßer. "This deficiency endangers our children," continued the expert. (fp)

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