Impact of the COVID-pandemic on the incidence of tonsil surgery and sore throat in Germany

Abstract

Purpose To longitudinally evaluate the impact of the COVID-19-pandemic on the incidence of inpatient tonsil surgery and outpatient primary care of sore throat in Germany. Methods A retrospective interrupted time-series analysis was conducted. The national database of the Hospital Remuneration System was used to retrieve the number of operations performed between January 2019 and September 2021 including elective and non-elective cases with the exception of malign diseases. Three episodes were compared on a weekly basis: before, during, and after the first national lockdown (March 16–May 3, 2020). We also analysed the number of outpatient doctor contacts of sore throat patients in 2019 and 2020. Results Overall, 144,069 surgical cases were included in the analysis. The first lockdown resulted in an abrupt and significant decrease of all types of tonsil surgery ( p < 0.01). The incidence of tonsillectomy decreased from 556 (before) to 111 (during) and 326 (after) cases per week (relative risk 0.24; 95% CI 0.19–0.30, and 0.82; 95% CI 0.73–0.92). After the lockdown, the incidence persisted on a lower level compared to 2019. The number of doctor contacts decreased from 2,967,322 in 2019 to 1,976,617 in 2020 (− 33.4%). Conclusions The first lockdown was associated with a significant decrease of all types of tonsil surgery. A return to pre-pandemic surgical activity was not identified. The findings were accompanied by a significant decrease of outpatient doctor contacts of sore throat patients in primary care, particularly in the subgroup of children and adolescents. The impact of the second lockdown, starting in December 2020, was by far not comparable. Supplementary Information The online version contains supplementary material available at 10.1007/s00405-022-07308-8.

How did the COVID-19 pandemic affect inpatient care for children in Germany? An exploratory analysis based on national hospital discharge data

“…While shifts from inpatient to outpatient treatment could not be investigated in this study due to the nature of the data, the plausibility of ambulatory care fully offsetting the difference in impatient procedures is questionable, given the substantial decrease in outpatient care visits that has also been observed in Germany since the beginning of the COVID-19 pandemic. 21 Our study has several limitations. Since the InEK data browser only contains pre-pandemic data for 2019, it was impossible to account for particularities in hospital admission numbers of that year or compare hospitalisation trends over several years, including decreasing tendencies in admissions for appendicitis and/or tonsillectomies/adenoidectomies before the pandemic; a better comparison would have been the ve-year-average before the pandemic.…”

“…29 The reductions in tonsillectomy and/or adenoidectomy procedures re ect the widespread postponement of elective interventions, as rst called for by the German government in mid-March 2020 and found in a recent population-wide analysis across all age groups. 21 Similar to the reduction in appendicitis hospitalisations, this drop may indicate a change in demand due to concerns about SARS-CoV-2 exposure. 21 However, it must be acknowledged that the evolution of clinical practice increasingly favours minimally invasive approaches that are performed in ambulatory settings 21 ; it is conceivable that the pandemic further accelerated this development.…”

“…18,19 During lockdowns, hospitals were advised to postpone elective non-urgent treatments to preserve capacity for the treatment of patients with COVID-19. 20,21 Lockdown periods coincide with substantial drops in admissions for tonsillectomies/adenoidectomies and less pronounced decreases in admissions for appendicitis, while admissions for ALL do not seem to be similarly affected. Linear trend lines show an overall steep decrease for tonsillectomies/adenoidectomies, a slight decrease for appendicitis and no change for ALL.…”

Does the Second Opinion Directive in Germany reach the patient? A parallel-convergent mixed- methods study

“…(113_SA, Pos. [33][34][35][36] The information about the right to obtain an SO is sometimes not provided by the physician who gave the indication, but rather by the surgeon during the pre-surgery consultation. "I: Have you been informed that you have the right to obtain a second opinion?…”

“…Many participating physicians did not recruit any patient. The Corona pandemic drastically reduced the number of elective surgeries and thus the indications were also reduced [35]. At the same time, there was a general decrease in tonsillectomies and hysterectomies in Germany [12,36].…”