Navigation Links
The great tonsil dilemma

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 identified. Meanwhile, the collective cost of those examinations is roughly $150,000.

"Looking grossly might seem like next best alternative to the expense of putting every specimen under the microscope," Thorne says. "But it may be the worst of both worlds the data show you're unlikely to find anything, but you're still incurring significant expense."

While better at identifying disease, microscopic examination also turned up few unsuspected problems. The incidence is so low that the researchers estimated over $750,000 would need to be spent for every case of lymphoma found.

Out of 1,066 microscopic examinations, 18 cases of disease were found, all of which were suspected before surgery either because a patient was known to be at higher risk because they had previously received an organ transplant or a surgeon noticed something suspicious and requested additional scrutiny.

No one is suggesting that discovering hidden cancers and other diseases isn't important, Thorne says. The question is what we might be giving up elsewhere in order to find those rare cases.

Part of the problem is a disconnect between the service and the payment. For a parent with insurance, there might be no additional out-of-pocket cost to have their child's tonsil's examined under a microscope. But as a society we have to balance those individual desires with the burden on the overall system, Thorne explains.

"If we're going to make a rational decision say, 'I don't care how much it costs, missing a lymphoma in a child is unacceptable' then we should be doing microscopy all the time. If we're just doing gross analysis, we're still spending a lot of money, yet we know we're unlikely to find anything that way."

Still, routine analysis has some non-clinical benefits, such as its use in training pathologists, the authors note.

Jonathan McHugh, M.D., an assistant professor of pathology at U-M Medical School and one of the study's authors, says some pathologists may be resistant to change because they think of themselves as the last line of defense.

"In this instance, I think the data shows we haven't been that valuable in that role," McHugh says.


Contact: Ian Demsky
University of Michigan Health System

Related medicine news :

1. Laser Spine Institute Honored at the Gridiron Greats Night of Champions
2. Jion Beijing Great Wall International Travel Agency Immediate Exposure to China Expo 2010
3. Akron Institute of Herzing University Launches Its First Bachelors Degree Programs to Prepare Students for Even Greater Success in Business, Health Care and IT
4. USA's Greatest Speed Skater Takes His Medical Practice to the Cutting Edge
5. Chronic Migraines Take a Greater Toll
6. Great Salt Lake Chapter of National Contract Management Association Hosts Presentation on False Claims Act by Qui Tam Attorney Tim Terry
7. Overweight middle-aged adults at greater risk for cognitive decline in later life
8. Lumension Enhances Compliance and IT Risk Management Solution for Greater IT GRC Efficiency
9. Co-Creator of Six Sigma Unveils “The Great Discovery” ... the 4th Generation of Six Sigma
10. KIWI Magazine Announces the Next Great Young Chef Contest--for Kids Who Love to Cook
11. Genetic variant greatly increases lung cancer risk for light smokers
Post Your Comments:
(Date:6/25/2016)... Long Beach, CA (PRWEB) , ... June 25, 2016 , ... ... from UCLA with Magna Cum Laude and his M.D from the David Geffen School ... San Diego and returned to Los Angeles to complete his fellowship in hematology/oncology at ...
(Date:6/24/2016)... ... June 24, 2016 , ... A recent article ... are unfamiliar with. The article goes on to state that individuals are now more ... these less common operations such as calf and cheek reduction. The Los Angeles area ...
(Date:6/24/2016)... ... June 24, 2016 , ... The Pulmonary Hypertension Association (PHA) ... will receive two significant new grants to support its work to advance research ... anniversary by recognizing patients, medical professionals and scientists for their work in fighting ...
(Date:6/24/2016)... ... ... BioMedics, Inc, makers of Topricin and MyPainAway Pain Relief Products, join The ‘Business for a ... an hour by 2020 and then adjusting it yearly to increase at the same rate ... assure the wage floor does not erode again, and make future increases more predictable. , ...
(Date:6/24/2016)... (PRWEB) , ... June 24, 2016 , ... ... client, The Grove Investment Group (TGIG), has initiated cultivation and processing operations at ... Las Vegas and Pahrump, Nevada. , Puradigm is the manufacturer of a complete ...
Breaking Medicine News(10 mins):
(Date:6/24/2016)... -- According to a new market research ... Safety Pen Needles), Needle Length (4mm, 5mm, 6mm, 8mm, ... Purchase (Retail, Non-Retail) - Trends & Global Forecasts to ... for the forecast period of 2016 to 2021. This ... 2021 from USD 1.65 Billion in 2016, growing at ...
(Date:6/24/2016)... , Belgium , June 24, ... VNRX), today announced the appointment of Dr. ... Directors as a Non-Executive Director, effective June 23, ... Audit, Compensation and Nominations and Governance Committees.  As ... Futcher will provide independent expertise and strategic counsel ...
(Date:6/23/2016)... 2016  MedSource announced today that it has ... solution of choice.  This latest decision demonstrates MedSource,s ... their clients by offering a state-of-the-art electronic data ... nowEDC as the EDC platform of choice in ... "nowEDC has long been a preferred EDC platform ...
Breaking Medicine Technology: