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The great tonsil dilemma
Date:2/8/2011

ANN ARBOR, Mich. Without fanfare, hundreds of thousands of children surrender their tonsils to a surgeon's scalpel each year, usually to alleviate recurring infections and obstructive sleep problems. Most of the time, the snipped tonsils are sent to a pathologist, who looks for evidence of more serious medical problems, like unsuspected cancer.

But this common practice may not be cost-effective because those additional examinations rarely lead to the discovery of hidden disease, a new University of Michigan Heath System analysis shows.

The approximately $35 million spent nationwide on such examinations each year might have more impact if spent elsewhere in the healthcare system, says the study's senior author, Marc C. Thorne, M.D., M.P.H., assistant professor of otolaryngology at the U-M Medical School.

"The question is: How do we make rational use of our heath care dollars?" asks Thorne. "It's a matter both of economics and of societal values."

The findings, published online ahead of print publication in the journal OtolaryngologyHead and Neck Surgery, are but a single example from the larger, ongoing debate about how to best conserve resources, create efficiencies and lower the cost of health care.

Pathologists examine tonsillectomy specimens in two ways: a visual, or "gross," examination and microscopy. Microscopic examination is nearly three times more expensive than visual inspection.

Forty-two percent of specimens receive gross analysis, 38 percent are examined under the microscope and 20 percent are discarded without examination, according to a 2001 survey of American Academy of Otolaryngology members.

To determine the effectiveness of each practice, Thorne and his colleagues pored over data from 5,235 tonsillectomies conducted at U-M between 1996 and 2008.

A pathologist performed a visual examination in 4,186 of those cases and zero cases of additional disease were identif
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Contact: Ian Demsky
idemsky@umich.edu
734-764-2220
University of Michigan Health System
Source:Eurekalert

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