Trends und regionale Variabilität der Tonsillenchirurgie in Deutschland

Data for the presented longitudinal study were requested from the German Federal Institute of Statistics. The Federal Institute of Statistics has been collecting and archiving nationwide data regarding inpatient treatments since 2005, hence homogeneity and high quality of data can be assumed. Sex-specific bleeding rates were calculated for the Federal Republic of Germany and each german federal state. The operation rates were calculated for the Federal Republic of Germany and the 16 german federal states under consideration of the official vital statistics. An analysis of variance (ANOVA), including Duncan’s Multiple Range Test and Kruskal-Wallis-Test, as well as a correlation analysis via Pearson’s Correlation Coefficient was performed. Results revealed similar averages in the operation rates of five of the 16 federal states, with clear influence by the patients´ gender: male patients displayed higher variance (six subgroups) than female patients (four subgroups). Postoperative bleeding rates could also be calculated for both sexes, the Federal Republic of Germany and each federal state. Male gender had a geographically independent significant negative influence upon the bleeding rate throughout the observation period. Geographically independent significant differences could also be observed among the bleeding rates of each federal state, when compared to each other. A positive correlation between operation and bleeding rates was found in 14 of 16 federal states, additionally female sex proved to be rather unfavourable: bleeding rates of female patients showed a higher correlation to operation rates than those of male patients. Further clinical studies can possibly explain the case decrease and reveal potential connections to the resulting treatment costs. Furthermore, operation indications for tonsil surgery, as well as possible connections between surgery and resulting complications can be recorded and analyzed elaborately. Finally, regional differences can be looked upon more thouroughly. The scientific questions asked in this study can be answered as follows: 1. How did the absolute and relative frequency of performed operations develop in Germany and the 16 federal states? The frequency of performed tonsillectomies and adenotonsillectomies sunk significantly during the observation period, whereas the frequency of performed tonsillotomies increased significantly. The frequency of performed rest tonsillectomies, abscess tonsillectomies and operation-worthy postoperative bleeding after tonsil surgery remained constant. 2. Did the coherence between postoperative bleeding requiring operation and sex change? The coherence between postoperative bleeding and sex remained constant during the observation period. Significantly lower bleeding rates could be noted for female patients in all federal states and throughout all years of observation when compared to those of male patients. 3. Can statistically significant regional differences in the operation and bleeding rates be noted? Significant regional differences were noted regarding operation and bleeding rates. Operation rates of Bremen and Hamburg were significantly higher than the german average for both male and female patients. No federal state showed significantly lower operation rates than the german average. Niedersachsen, Berlin and Baden-Württemberg showed significantly higher operation-worthy bleeding rates, when compared to the german average for both sexes, whereas the bleeding rates of Sachsen-Anhalt, Mecklenburg-Vorpommern, Nordrhein-Westfalen, Rheinland-Pfalz, Saarland and Thüringen were significantly lower than the german average for both sexes. Bleeding rates of Schleswig-Holstein, Hamburg, Bremen, Hessen and Sachsen were similar to the german average for both sexes. Differences in the bleeding rates among sexes could be found in Bayern and Brandenburg. 4. Do above average operation rates lead to lower bleeding rates? A significant correlation among operation and bleeding rates could be noted for all federal states but Schleswig-Holstein and Hamburg. Since all correlation coefficients showed positive values, a rising bleeding rate can be expected with rising operation rates. A contrary effect could not be detected.