Abstract
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.
Highlights
Sleep-disordered breathing (SDB) is a common disorder in children, affecting 4–11% with symptoms of snoring, apneas and choking sounds during sleep [1]
Studies have shown a lower risk of postoperative bleeding and less pain after tonsillotomy compared with tonsillectomy [3, 4]
In 2011, the National Tonsil Surgery Register in Sweden (NTSRS) included 77.5% of all tonsil surgeries performed in Sweden in 2011 and all registered children aged 1–11 with the main indication upper airway obstruction were included in the study
Summary
Sleep-disordered breathing (SDB) is a common disorder in children, affecting 4–11% with symptoms of snoring, apneas and choking sounds during sleep [1]. Tonsillectomy with or without adenoidectomy (TE ± A) has been the treatment of choice for children with sleep-disordered breathing due to adenotonsillar hypertrophy. In Sweden, tonsillotomy (TT) has replaced tonsillectomy as the recommended treatment for children with SDB due to tonsillar hypertrophy [2]. Studies have shown a lower risk of postoperative bleeding and less pain after tonsillotomy compared with tonsillectomy [3, 4]. Tonsillectomy is still, the preferred method of surgery for chronic or recurrent tonsillitis. Tonsil surgery is one of the most common surgical procedures performed in children under general anaesthesia, with more than 500,000 procedures performed annually in the USA [5]
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