Incidence Of Tonsillectomy Research Articles

Deductible Status in the Pediatric Population: A Barrier to Appropriate Care?

The objective of this study is to evaluate the impact of high-deductible health plans on elective surgery (tonsillectomy) in the pediatric population. Cross-sectional study. Health claims database from a third-party payer. Data were reviewed for children up to 18 years of age who underwent tonsillectomy or arm fracture repair (nonelective control) from 2016 to 2019. Incidence of surgery by health plan deductible (high, low, or government insured) and met or unmet status of deductibles were compared. A total of 10,047 tonsillectomy claims and 9903 arm fracture repair claims met inclusion and exclusion criteria. The incidence of tonsillectomy was significantly different across deductible plan types. Patients with met deductibles were more likely to undergo tonsillectomy. In patients with deductibles ≥$4000, a 1.75-fold increase in tonsillectomy was observed in those who had met their deductible as compared with those who had not. These findings were not observed in controls (nonelective arm fracture). For those with met deductibles, those with high deductibles were much more likely to undergo tonsillectomy than those with low, moderate, and government deductibles. Unmet high deductibles were least likely to undergo tonsillectomy. Health insurance plan type influences the incidence of pediatric elective surgery such as tonsillectomy but not procedures such as nonelective repair of arm fracture. High deductibles may discourage elective surgery for those deductibles that are unmet, risking inappropriate care of vulnerable pediatric patients. However, meeting the deductible may increase incidence, raising the question of overutilization.

What Is the Impact of Prior Authorization on the Incidence of Pediatric Tonsillectomy?

Third-party payers advocate for prior authorization (PA) to reduce overutilization of health care resources. The impact of PA in elective surgery is understudied, especially in cases where evidence-based clinical practice guidelines define operative candidacy. The objective of this study is to investigate the impact of PA on the incidence of pediatric tonsillectomy. Cross-sectional study. Health claims database from a third-party payer. Any pediatric patient who had evaluation for tonsillectomy from 2016 to 2019 was eligible for inclusion. A time series analysis was used to evaluate the change in incidence of tonsillectomy before and after PA. Lag time from consultation to surgery before and after PA was compared with segmented regression. A total of 10,047 tonsillectomy claims met inclusion and exclusion criteria. Female patients made up 51% of claims, and the mean age was 7.9 years. Just 1.5% of claims were denied after PA implementation. There was no change in the incidence of tonsillectomy for all plan types (P = .1). Increased lag time from consultation to surgery was noted immediately after PA implementation by 2.38 days (95% CI, 0.23-4.54; P = .030); otherwise, there was no significant change over time (P = .98). A modest number of tonsillectomy claims were denied approval after implementation of PA. The value of PA for pediatric tonsillectomy is questionable, as it did not result in decreased incidence of tonsillectomy in this cohort.

The Handle of the Broom

Alison Glover was one of the first to document significant practice variation in clinical care in a study on the incidence of tonsillectomy in school-age children in the United Kingdom in 1938.[1][1] Since that time, there have been a number of studies linking clinical care practice variation with

What Lessons Can Be Learned from the Austrian Events?

Introduction: The death of 5 children in Austria below the age of 6 years due to posttonsillectomy haemorrhage in 2006 and 2007 led to an intensive discussion on the potential life-threatening risks of tonsil surgery. On this occasion, a consensus paper with clear recommendations for tonsil surgery was released by the Austrian Societies of Otorhinolaryngology, Head and Neck Surgery and Paediatrics followed by a nationwide multicentre study. Methods: All consecutive tonsillectomies, tonsillotomies and adenoidectomies performed in public hospitals in Austria within 9 months were assessed. Data on all participating patients were collected via an online questionnaire requesting patient characteristics, surgery details and postoperative haemorrhage. A strict definition for postoperative bleeding episodes with 7 severity grades was applied. Every bleeding episode after extubation was counted as postoperative bleeding event. Results: The study population - all younger than 18 years of age - consisted of 6,765 patients (tonsillectomy 2,080, 31%; tonsillotomy 1,292, 19%; adenoidectomy 3,393, 50%). Postoperative haemorrhage episodes were reported in 15% after tonsillectomy and in 2.3% after tonsillotomy, with the risk increasing parallel to age. Multiple bleeding episodes were recorded in one fourth of all tonsillectomy bleedings, but were rare after tonsillotomy. Surgical revision under general anaesthesia was necessary in 4.2% after tonsillectomy and in 0.9% after tonsillotomy. Discussion: As the incidence of tonsillectomy in children younger than 6 years has declined following the recommendations of the consensus paper issued in 2007, tonsillotomy has become more frequent in this age group. Overnight hospital admission and observation is suggested for all patients experiencing postoperative haemorrhage, as the occurrence of one minor bleeding doubled the risk of a second severe bleeding.

The Incidence of Tonsillectomy in School children

The Incidence of Tonsillectomy in School children

Correlation of Dairy Food Intake with Human Antibody to Bovine Milk Xanthine Oxidase

SummarySeventy-three out of 94 human subjects were found to have antibodies to BMXO. Individuals with no BMXO titer had the lowest dairy food consumption of the population tested and there appears to be an inverse relationship between increased dairy fat consumption and decrease in IgA and IgM concentrations in titer groups 1-4. When divided into arbitrary groups according to the geometric mean titer, BMXO titers were higher as the milkfat and whole milk consumption increased (Fig. 1). Multiple regression analysis of the data indicated highly significant correlations (P < 0.0001) between milkshake consumption, milk consumption in early life, abnormal lipoprotein patterns, low serum glucose level and the incidence of tonsillectomy at age 10 or later with the presence of antibodies to BMXO. These correlations and the observation that higher milkfat and whole milk consumption resulted in higher BMXO titers suggest the uptake of dietary BMXO from the gut.

Incidence of tonsillectomy, circumcision, and appendicectomy among R.A.F. recruits.

Incidence of tonsillectomy, circumcision, and appendicectomy among R.A.F. recruits.

A study of rheumatic fever and streptococcal infection in different social groups in Melbourne.

1. Hospital records of 1469 cases of rheumatic fever (including chorea) up to the age of 14 years were used to study the social distribution of the disease in Melbourne. On this evidence the incidence of rheumatic fever was three times greater in low than in high rental districts.2. The results of throat-swab surveys and Dick tests on schoolchildren living in different districts showed that children in the poor districts contracted streptococcal infections more frequently than those in well-to-do districts.3. One factor associated with the carrier rate ofStreptococcus pyogenesin the various social groups was the incidence of tonsillectomy. In the better class districts where the tonsillectomy rate was high (60%) theStr. pyogenescarrier rate was 12.5%, whereas the rates in poor areas were 35 and 25.3% respectively.4. Differences in social incidence of rheumatic fever might therefore be explained by differences in social incidence of streptococcal infection, which, in turn, might be influenced by the incidence of tonsillectomy.We wish to thank the many persons who so willingly assisted in the collection of data for this study, particularly Dr H. L. Stokes and Dr M. M. Wilson, and Dr R. E. O. Williams for advice on presentation. This work was supported by a grant to one of us (Dr M. C. Holmes) from the Commonwealth Research Fund from the University of Melbourne.

The incidence of tonsillectomy in school children

The incidence of tonsillectomy in school children

The Incidence of Tonsillectomy in School Children

The Incidence of Tonsillectomy in School Children

TONSILLECTOMY

Since the throat is the site of the primary, if not the most important, lesion in scarlet fever, it is reasonable to suppose that the tonsils play an important role in this disease. In this article, an attempt is made to study particularly the effect of tonsillectomy on the incidence, severity and complications and on the occurrence of hemolytic streptococci in the throat during the course of the disease. In 1930, by actual examination, the incidence of tonsillectomy among 36,038 school children from 5 to 14 years of age was determined. 1 The group represented 52 schools and was a fair sample of the city of Rochester. The percentage of children operated on varied according to the school, the lowest percentage being 19, and the highest 64. The incidence of tonsillectomy also varied with social status, being highest among the well-to-do and the clinic clientele and lowest among the middle